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Weakness of expiratory muscles and pulmonary complications in malnourished patients undergoing upper abdominal surgery

  1. ADRIANA C. LUNARDI1,
  2. CAMILA S. MIRANDA1,
  3. KAROLINE M. SILVA1,
  4. IVAN CECCONELLO2,
  5. CELSO R.F. CARVALHO1,*

Article first published online: 21 DEC 2011

DOI: 10.1111/j.1440-1843.2011.02049.x

Issue

Respirology

Respirology

Volume 17, Issue 1, pages 108–113, January 2012

Additional Information

How to Cite

LUNARDI, A. C., MIRANDA, C. S., SILVA, K. M., CECCONELLO, I. and CARVALHO, C. R.F. (2012), Weakness of expiratory muscles and pulmonary complications in malnourished patients undergoing upper abdominal surgery. Respirology, 17: 108–113. doi: 10.1111/j.1440-1843.2011.02049.x

Author Information

  1. 1

    Departments of Physical Therapy

  2. 2

    Gastroenterology, Digestive Surgery Division, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil

*Celso R.F. Carvalho, Av Dr Arnaldo, 455, Room 1210, School of Medicine, University of Sao Paulo, 01246-903 Sao Paulo, Brazil. Email: cscarval@usp.br

Publication History

  1. Issue published online: 21 DEC 2011
  2. Article first published online: 21 DEC 2011
  3. Accepted manuscript online: 24 AUG 2011 11:40AM EST
  4. Received 2 March 2011; invited to revise 29 March 2011; revised 15 May 2011; accepted 14 June 2011 (Associate Editor: David Feller-Kopman).

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Keywords:

  • malnutrition;
  • perioperative care;
  • postoperative complication;
  • respiratory muscle;
  • surgery

ABSTRACT

Background and objective:  Malnutrition is prevalent in hospitalized patients and causes systemic damage including effects on the respiratory and immune systems, as well as predisposing to infection and increasing postoperative complications and mortality. This study aimed to assess the impact of malnutrition on the rate of postoperative pulmonary complications, respiratory muscle strength and chest wall expansion in patients undergoing elective upper abdominal surgery.

Methods:  Seventy-five consecutive candidates for upper abdominal surgery (39 in the malnourished group (MNG) and 36 in the control group (CG)) were enrolled in this prospective controlled cohort study. All patients were evaluated for nutritional status, respiratory muscle strength, chest wall expansion and lung function before surgery. Postoperative pulmonary complications (pneumonia, tracheobronchitis, atelectasis and acute respiratory failure) before discharge from hospital were also evaluated.

Results:  The MNG showed expiratory muscle weakness (MNG 65 ± 24 vs CG 82 ± 22 cm H2O; P < 0.001) and decreased chest wall expansion (P < 0.001), whereas inspiratory muscle strength and lung function were preserved (P > 0.05). The MNG also had a higher incidence of postoperative pulmonary complications compared with the CG (31% and 11%, respectively; P = 0.05). In addition, expiratory muscle weakness was correlated with BMI in the MNG (r = 0.43; P < 0.01). The association between malnutrition and expiratory muscle weakness increased the likelihood of postoperative pulmonary complications after upper abdominal surgery (P = 0.02).

Conclusions:  These results show that malnutrition is associated with weakness of the expiratory muscles, decreased chest wall expansion and increased incidence of pulmonary complications in patients undergoing elective upper abdominal surgery.

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