The effects of inspiratory muscle training were more robust, with significant reductions in hospital length of stay (by a mean of 2.1 days) and risk of postoperative pulmonary complications (by 58%). To

obtain these benefits, clinicians should deliver inspiratory muscle training as follows: 6 to 7 times a week for two to four weeks (supervised once a week by a physiotherapist); starting at a resistance of 15 to 30% of maximal inspiratory pressure and increasing by 5% each session (or if the Borg scale < 5). It should be noted, however, that these findings were primarily from trials with participants at high risk of pulmonary complications. Thirteen patients would need to be treated with inspiratory muscle training to prevent one postoperative pulmonary complication. In

addition, shortening hospital length of stay by two days would be of considerable significance to the public healthcare system in Australia, particularly where earlier learn more discharge frees up beds to allow hospitals to meet emergency department treatment time targets. In addition, whether treating 13 patients preoperatively to reduce postoperative pulmonary complications is worthwhile depends on the cost-effectiveness of treatment and healthcare resource allocation, and the cost of the postoperative pulmonary complications. The resources required to prevent one postoperative pulmonary complication may be better utilised in other health areas if they generate better health outcomes. Furthermore, this review did not take into account unobserved or unreported benefits that may stem from avoiding selleck chemicals a postoperative pulmonary complications, for example, avoiding patient discomfort and the risk and cost of investigations or treatment (eg, chest radiograph, antibiotics). None of the studies investigating inspiratory muscle training reported on costs, but both studies of counselling/goal setting reported that their intervention was cost-effective. More research is therefore needed to ascertain whether the specific health benefits

applicable to each intervention are worthwhile and cost-effective, despite their statistically because significant effect. Two studies26 and 27 used a validated model to identify the risk of cardiac surgery patients developing a postoperative pulmonary complication37 and targeted their intervention to patients determined a priori as high-risk. It is therefore possible that preoperative inspiratory muscle training is most effective in people at risk of developing postoperative pulmonary complications. Another study 28 attempted this risk stratification by targeting people diagnosed with chronic obstructive pulmonary disease (COPD) because, despite little evidence that people with COPD undergoing cardiac surgery are at higher risk of developing postoperative pulmonary complications, it could be expected that this would be observed, as in other populations such as people undergoing upper abdominal surgery.