The great clinical efficacy of an enhanced recovery after surgery (ERAS) program has been illustrated by the decreased incidence of perioperative complications and the shortened length of in-hospital stay. Furthermore, the ERAS programs have their own key techniques and strategies in the clinical application to the unique diseases and operative modes. The key technology of an ERAS program is the minimally invasive surgery, which has been widely utilized in the surgical specialties. The main strategy in an ERAS program consists of the intensive pulmonary rehabilitation and optimal perioperative care that aim to improve the in-hospital outcomes of lung cancer patients who are considered at high surgical risk. Pulmonary rehabilitation is regarded as the mainstay of the ERAS strategies but its clinical protocols still remain less mature. The purpose of this overview is to summarize the current pulmonary rehabilitation programs in terms of the suitable crowd, the feasible protocols and the clinical significance.
Objective To investigate the effects of mask BiPAP noninvasive positive ventilation (NIPPV) during treadmill exercise on dyspnea index and exercise endurance in stable patients with severe chronic obstructive pulmonary disease (COPD). Methods Twenty inpatients with stable severe COPD between August 2015 and January 2016 were recruited in the study. The following parameters were measured before and after 8-week rehabilitation by NIPPV during treadmill exercises, including 12-minute walking distance (12MWD), Borg dyspnea score, mean pulmonary arterial pressure (mPAP), PaO 2 and PaCO 2, times of acute exacerbation in 1 year, adverse reactions, and adherence. Results After rehabilitation for 8 weeks, the following parameters were improved than those before treatment including 12MWD [(810±20) mvs. (680±15) m,P<0.01], Borg dyspnea score (2.4±0.1vs. 4.4±0.3,P<0.01), mPAP [(34.4±2.7) mm Hgvs. (43.5±3.8) mm Hg], PaCO 2 [(49.8±4.9) mm Hgvs. (64.3±5.2) mm Hg], PaO 2 [(64.4±4.1) mm Hgvs. (52.3±3.9) mm Hg] and the times of acute exacerbation (2.1±0.7vs. 4.3±2.1,P<0.01). Adverse reactions included oropharyngeal drying (2 cases) and gaseous distention (8 cases) which can be tolerated without special treatment. Conclusion Mask NIPPV during treadmill exercise is safe and effective for stable patients with severe COPD and worthy of clinical application.
Pulmonary rehabilitation (PR) is a comprehensive intervention to the chronic respiratory diseases, that its benefits in chronic obstructive pulmonary disease (COPD) have been well established. Localization of PR in China is one of the key health strategies as there are nearly 100 million patients with COPD which causes huge disease burden. In addition, the evidence of PR for patients with other chronic respiratory diseases and post-thoracic surgery should be accumulated too. Now clinician, patients, and policy makers have few recognition of PR, which needs large-scaled standardized training and popularizing. This article starts with the definition of PR, reviews its population, implementation, settings, as well as the current situation of PR in our country in order to make clinicians, researchers, and policy makers have better understanding of PR and to make some suggestions on direction of the future research and clinical work.
[Abstract]Lung cancer exhibits the highest incidence and mortality rates among malignancies in China. As a critical component of comprehensive lung cancer management, pulmonary rehabilitation (PR) has emerged as a prominent research focus. PR employs multimodal interventions to improve functional capacity and quality of life in lung cancer patients, with applicability across all disease stages. However, challenges persist, including the lack of standardized protocols, uncertainty regarding optimal implementation timing, and suboptimal patient adherence. Technological innovations hold significant potential, and future efforts should prioritize personalized regimens and optimized interventions to advance its widespread clinical adoption.
ObjectiveTo understand the obstacles in the practice of pulmonary rehabilitation between doctors and patients.MethodsMedical staff and patients with chronic obstructive pulmonary disease (COPD) in public hospitals in this region were randomly sampled, and a questionnaire survey was conducted on possible obstacles to the practice of pulmonary rehabilitation.ResultsTotal of 265 medical staff and 120 COPD patients were recruited in this survey. The obstacles of pulmonary rehabilitation practice of medical staff in clinical work are poor cooperation of patients and their families (84.2%), medical staff’s insufficient awareness of pulmonary rehabilitation (82.3%), and lack of practice and guidelines (78.9%), lack of objective conditions such as site, equipment and equipment (75.1%), lack of multidisciplinary teams (74.3%), pulmonary rehabilitation has fallen by the wayside (73.6%) etc. The main obstacles for COPD patients in pulmonary rehabilitation are lack of access to relevant knowledge (52.4%), insufficient knowledge (36.5%), inconvenient transportation, economic problems and other objective conditions (33.3%). After multiple correspondence analysis, there are differences in the degree of correlation between obstacle factors and groups with different characteristics.ConclusionsThere are many factors hindering the development of pulmonary rehabilitation and there are certain differences among different populations, but the lack of understanding of pulmonary rehabilitation between doctors and patients is the primary problem. It is necessary to improve the cognition of both doctors and patients on pulmonary rehabilitation, and then to solve the obstacles in the implementation of pulmonary rehabilitation.
ObjectiveTo systematically analyse the application of pulmonary rehabilitation in patients with stroke-associated pneumonia (SAP), in order to provide reference for clinical healthcare professionals to carry out relevant interventions. Methods PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were systematically searched, with a search period from database establishment until December 31, 2023. The scoping review method was used to analyze the included studies. Results A total of 16 studies were included, mainly randomized controlled trials and quasi-experimental studies. The research mainly focuses on China and South Korea. The sample size was generally 40-80 cases. The duration of intervention is mostly 2-4 weeks. Six different lung rehabilitation interventions were involved. The main outcome measures included lung function, incidence of SAP, mortality rate, cognitive function, severity of stroke, length of intensive care unit stay, duration of antibiotic use, and daily living activity. Most studies had shown that lung rehabilitation has a significant impact on SAP patients.Conclusions The effectiveness of pulmonary rehabilitation in SAP patients has been preliminarily validated. Future research needs to cover a wider range of regions and larger samples, and conduct long-term tracking studies and multidimensional evaluations to enhance the universality and reliability of the results.
The pulmonary rehabilitation treatment of patients with chronic obstructive pulmonary disease (COPD) has become a current research hotspot. Pulmonary rehabilitation can effectively improve the lung function, quality of life, and physical and mental health, reduce the risk of death, but there are still certain limitations in the implementation of pulmonary rehabilitation for COPD. Based on existing research, this article introduces the benefits of pulmonary rehabilitation for COPD, and elaborates on the timing, location selection, and course of pulmonary rehabilitation, aiming to provide a basis for developing personalized pulmonary rehabilitation plans for COPD.
Objective To examine the effects of pulmonary rehabilitation training on pulmonary function in patients post-stroke. Methods We searched Cochrane Library, PubMed, ProQuest, Embase, China National Knowledge Infrastructure, Wangfang Database, Chinese Biomedical Database, and VIP Chinese Science and Technology Journal Database for randomized controlled trials of investigating the effects of pulmonary rehabilitation training on pulmonary function in stroke patients published before September 2018. The patients in the training group were treated with pulmonary rehabilitation, including respiratory muscle training, chest breathing, or abdominal breathing training, with or without respiratory training device. The patients in the control group received conventional stroke rehabilitation. The outcome indicators included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1 percentage predicted (FEV1%pred), peak expiratory flow rate, maximal inspiratory pressure (PImax), maximal expiratory pressure, exercise endurance, and quality of life. Two researchers independently carried out literature retrieval and data extraction, using Physiotherapy Evidence Database scale, and standard data extraction forms adapted from Cochrane Collaboration model to evaluate the studies quality. The Meta-analysis was performed using Review Manager Version 5.3. Results Eleven studies met the study criteria with a total of 500 stroke patients, including 274 patients in the training group and 226 patients in the control group, respectively. The Meta-analysis showed that after pulmonary rehabilitation training, the values of FVC [mean difference (MD)=0.30 L, 95% confidence interval (CI)(0.26, 0.34) L, P<0.000 01], FEV1 [MD=0.28 L, 95%CI (0.25, 0.32) L, P<0.000 01], and 6-minute walking test [MD=43.43 m, 95%CI (7.92, 78.95) m, P=0.02] in the training group were significantly higher than those in the control group, as well as the change of PImax [MD=6.49 cm H2O (1 cm H2O=0.098 kPa), 95%CI (3.67, 9.32) cm H2O, P<0.000 1]. The advantages of pulmonary rehabilitation training had not been found in improving FEV1/FVC and FEV1%pred (P>0.05). Conclusions The implementation of pulmonary rehabilitation training in the way of respiratory muscle training combined with conventional rehabilitation therapy could improve two kinds of indicators of pulmonary function referring to FVC and FEV1, inspiratory muscle strength and 6-minute waking distance. The long-term effect of pulmonary rehabilitation training on stroke patients, the respiratory training mode of different prescriptions, the endurance of exercise and the quality of life need further study.
ObjectiveTo clarify the effectiveness of preoperative pulmonary rehabilitation (PPR) and provide evidence for the application of PPR on lung cancer patients by meta-analysis.MethodsAccording to inclusion and exclusion criteria, literatures related to PPR on lung cancer patients were retrieved from major databases between the date of establishment of each database and January 2019, and then data required were extracted from the selected literatures. Meta-analysis was conducted by RevMan 5.0.ResultsTwelve randomized controlled trials were involved in meta-analysis, including 658 patients who were well-diagnosed and prepared for surgery, with 307 patients in the PPR group and 351 patients in the control group. The results of the meta-analysis showed that in the PPR group, the pulmonary function including forced vital capacity [MD=0.31, 95%CI (0.21, 0.42), P<0.01], forced expiratory volume in one second [MD=0.27, 95%CI (0.20, 0.34), P<0.01] and activity tolerance including 6-minute walk distance [MD=50.55, 95%CI (35.98, 65.13), P<0.01] were significantly better than the control group, and the postoperative complication rate was lower ［MD=0.28, 95%CI (0.18, 0.43), P<0.01］, postoperative hospital stay was shorter [MD=–2.09, 95%CI (–2.41, –1.77), P<0.01].ConclusionsA period of PPR on lung cancer patients can improve postoperative pulmonary function and activity tolerance, and reduce postoperative complications and hospital stay, which is beneficial to postoperative recovery.