Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities
Abstract
:1. Introduction
2. Surgical Stress and Physiological Responses
2.1. Neuroendocrine and Inflammatory Pathways
2.2. Biological and Clinical Expression of the Stress Response
3. Postoperative Complications
4. Preoperative Assessment and Risk Factors for Postoperative Complications
4.1. Clinical Assessment
4.2. Cardiac and Respiratory Assessment
4.3. Functional Assessment
5. Implementation of a Prehabilitation Program
5.1. Optimized Medical Treatment and Correction of Nutritional Deficits
5.2. Patient Education and Hygienic Interventions
5.3. Exercise Training
5.3.1. Type of Exercise
5.3.2. Mechanisms of Training-Induced Improvements
5.3.3. Clinical Medicine
5.3.4. Physical Training Program before Major Surgery
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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System Involved | MILD—Self-Limited | MODERATE | SEVERE | CRITICAL |
---|---|---|---|---|
Cardiovascular |
|
|
|
|
Respiratory |
|
|
|
|
Renal |
| KDIGO stage 1
| KDIGO stage 2
| |
Cerebral |
|
|
|
|
Bleeding |
|
|
| |
Patient-centered outcome |
|
|
|
|
Others |
|
|
|
|
Risk Assessment | Score or Test | Characteristics and Interpretation |
---|---|---|
General | ASA-PS American Society of Anesthesiology-Physical status 6 classes |
|
Cardiac | Revised Cardiac Risk Index 6 items |
|
Pulmonary | ARISCAT Assess Respiratory Risk in Surgical Patients in Catalonia 7 items |
|
Exercise tolerance | MET Metabolic Equivalent Task |
|
Cardiopulmonary exercise test peak oxygen consumption (VO2) Stair Climbing |
| |
Sarcopenia | Mini-nutritional assessment 12–14: normal 8–11: at risk <8: malnutrition |
|
Frailty | Clinical Frailty Scale Scale with 9 grades |
|
Health Quality of life | EQ-5D Rate 5 domains (5 grades: no problem, slight, moderate, severe, extreme) |
|
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Licker, M.; El Manser, D.; Bonnardel, E.; Massias, S.; Soualhi, I.M.; Saint-Leger, C.; Koeltz, A. Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities. J. Clin. Med. 2024, 13, 2765. https://doi.org/10.3390/jcm13102765
Licker M, El Manser D, Bonnardel E, Massias S, Soualhi IM, Saint-Leger C, Koeltz A. Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities. Journal of Clinical Medicine. 2024; 13(10):2765. https://doi.org/10.3390/jcm13102765
Chicago/Turabian StyleLicker, Marc, Diae El Manser, Eline Bonnardel, Sylvain Massias, Islem Mohamed Soualhi, Charlotte Saint-Leger, and Adrien Koeltz. 2024. "Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities" Journal of Clinical Medicine 13, no. 10: 2765. https://doi.org/10.3390/jcm13102765