Multimodal prehabilitation before lung resection surgery: a
multicentre randomised controlled trial

J 2025

Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial

BRAT, Kristián; Milan SOVA; Pavel HOMOLKA; Marek PLUTINSKÝ; Samuel GENZOR et. al.

Základní údaje

Originální název

Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial

Autoři

Vydání

British Journal of Anaesthesia, London, Elsevier Ltd. 2025, 0007-0912

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30223 Anaesthesiology

Stát vydavatele

Velká Británie a Severní Irsko

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 9.200 v roce 2024

Organizační jednotka

Lékařská fakulta

DOI

https://doi.org/10.1016/j.bja.2025.03.018

UT WoS

001518614700008

EID Scopus

2-s2.0-105005511206

Klíčová slova anglicky

cardiopulmonary exercise testing; lung resection surgery; postoperative complications; prehabilitation; ventilatory efficiency

Štítky

14110118, 14110120, 14110122, 14110215, 14110223, 14110234, 14119612, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 8. 8. 2025 09:54, Mgr. Tereza Miškechová

Anotace

V originále

Background: Respiratory muscle training may improve ventilatory efficiency (VE/VCO2 slope), a strong predictor of postoperative pulmonary complications. We hypothesised that multimodal prehabilitation, incorporating high-intensity respiratory muscle training, before lung resection would reduce postoperative complications and length of hospital stay. Methods: We conducted a prospective multicentre, randomised controlled trial (NCT04826575) to examine the effect of prehabilitation in individuals undergoing lung resection. Participants were defined as high-risk for postoperative pulmonary complications if they achieved VE/VCO2 slope >= 33, as determined by cardiopulmonary exercise testing. Participants were then randomised to either usual care or multimodal prehabilitation, which consisted of a 14-day programme of high-intensity respiratory muscle training, smoking cessation, nutritional support, and psychological support. The primary outcome were postoperative pulmonary and cardiovascular complications (pneumonia, atelectasis, respiratory failure necessitating mechanical ventilation, adult respiratory distress syndrome, prolonged air leak). Results: A total of 122 patients (46% female; age range: 64-75 yr) completed the study. Postoperative pulmonary complications occurred in 20/58 (34%) of patients randomised to multimodal prehabilitation, compared with 35/64 (55%) patients receiving usual care (odds ratio 2.29 [95% confidence interval 1.10-4.77]; P=0.029). Hospital length of stay was shorter after multimodal rehabilitation compared with patients randomised to receive usual care (from 9 [7-11] days to 7 [6-9] days; P=0.038). After prehabilitation, mean (SD) VE/VCO2 slope decreased from 39 (8) to 36 (9); P=0.01. Prehabilitation also improved patient-reported quality of life measures. Conclusions: In high-risk patients undergoing elective lung resection surgery, multimodal prehabilitation, including high-intensity respiratory muscle training to target VE/VCO2, reduced postoperative pulmonary complications and hospital length of stay.

Citovat

BRAT, Kristián; Milan SOVA; Pavel HOMOLKA; Marek PLUTINSKÝ; Samuel GENZOR; Alena POKORNÁ; Filip DOSBABA; Barbora IMRICHOVA; Zdeněk CHOVANEC; Ladislav MITÁŠ; Monika MIKULASKOVA; Michal SVOBODA; Lyle OLSON a Ivan ČUNDRLE. Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial. British Journal of Anaesthesia. London: Elsevier Ltd., 2025, roč. 135, č. 1, s. 188-196. ISSN 0007-0912. Dostupné z: https://doi.org/10.1016/j.bja.2025.03.018.

@article{2511410,
   author = {Brat, Kristián and Sova, Milan and Homolka, Pavel and Plutinský, Marek and Genzor, Samuel and Pokorná, Alena and Dosbaba, Filip and Imrichova, Barbora and Chovanec, Zdeněk and Mitáš, Ladislav and Mikulaskova, Monika and Svoboda, Michal and Olson, Lyle and Čundrle, Ivan},
   article_location = {London},
   article_number = {1},
   doi = {https://doi.org/10.1016/j.bja.2025.03.018},
   keywords = {cardiopulmonary exercise testing; lung resection surgery; postoperative complications; prehabilitation; ventilatory efficiency},
   language = {eng},
   issn = {0007-0912},
   journal = {British Journal of Anaesthesia},
   title = {Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial},
   url = {https://www.sciencedirect.com/science/article/pii/S0007091225001965?via%3Dihub},
   volume = {135},
   year = {2025}
}

TY  - JOUR
ID  - 2511410
AU  - Brat, Kristián - Sova, Milan - Homolka, Pavel - Plutinský, Marek - Genzor, Samuel - Pokorná, Alena - Dosbaba, Filip - Imrichova, Barbora - Chovanec, Zdeněk - Mitáš, Ladislav - Mikulaskova, Monika - Svoboda, Michal - Olson, Lyle - Čundrle, Ivan
PY  - 2025
TI  - Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial
JF  - British Journal of Anaesthesia
VL  - 135
IS  - 1
SP  - 188-196
EP  - 188-196
PB  - Elsevier Ltd.
SN  - 00070912
KW  - cardiopulmonary exercise testing
KW  - lung resection surgery
KW  - postoperative complications
KW  - prehabilitation
KW  - ventilatory efficiency
UR  - https://www.sciencedirect.com/science/article/pii/S0007091225001965?via%3Dihub
N2  - Background: Respiratory muscle training may improve ventilatory efficiency (VE/VCO2 slope), a strong predictor of postoperative pulmonary complications. We hypothesised that multimodal prehabilitation, incorporating high-intensity respiratory muscle training, before lung resection would reduce postoperative complications and length of hospital stay. Methods: We conducted a prospective multicentre, randomised controlled trial (NCT04826575) to examine the effect of prehabilitation in individuals undergoing lung resection. Participants were defined as high-risk for postoperative pulmonary complications if they achieved VE/VCO2 slope >= 33, as determined by cardiopulmonary exercise testing. Participants were then randomised to either usual care or multimodal prehabilitation, which consisted of a 14-day programme of high-intensity respiratory muscle training, smoking cessation, nutritional support, and psychological support. The primary outcome were postoperative pulmonary and cardiovascular complications (pneumonia, atelectasis, respiratory failure necessitating mechanical ventilation, adult respiratory distress syndrome, prolonged air leak). Results: A total of 122 patients (46% female; age range: 64-75 yr) completed the study. Postoperative pulmonary complications occurred in 20/58 (34%) of patients randomised to multimodal prehabilitation, compared with 35/64 (55%) patients receiving usual care (odds ratio 2.29 [95% confidence interval 1.10-4.77]; P=0.029). Hospital length of stay was shorter after multimodal rehabilitation compared with patients randomised to receive usual care (from 9 [7-11] days to 7 [6-9] days; P=0.038). After prehabilitation, mean (SD) VE/VCO2 slope decreased from 39 (8) to 36 (9); P=0.01. Prehabilitation also improved patient-reported quality of life measures. Conclusions: In high-risk patients undergoing elective lung resection surgery, multimodal prehabilitation, including high-intensity respiratory muscle training to target VE/VCO2, reduced postoperative pulmonary complications and hospital length of stay.
ER  -

BRAT, Kristián; Milan SOVA; Pavel HOMOLKA; Marek PLUTINSKÝ; Samuel GENZOR; Alena POKORNÁ; Filip DOSBABA; Barbora IMRICHOVA; Zdeněk CHOVANEC; Ladislav MITÁŠ; Monika MIKULASKOVA; Michal SVOBODA; Lyle OLSON a Ivan ČUNDRLE. Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial. \textit{British Journal of Anaesthesia}. London: Elsevier Ltd., 2025, roč.~135, č.~1, s.~188-196. ISSN~0007-0912. Dostupné z: https://doi.org/10.1016/j.bja.2025.03.018.

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