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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: The randomized clinical trial by Dr Hulzebos and colleagues¹ suggested that preoperative inspiratory muscle training (IMT) may reduce the incidence of postoperative pulmonary complications in high-risk patients undergoing coronary artery bypass graft (CABG) surgery. However, there was important additional detail that was not provided.

First, there was no specification of the measurements of the efficacy of IMT. It was not stated how the recordings of maximal inspiratory and expiratory pressures and of endurance were performed. The recording and interpretation of these outcome measures² are critical to assess validity of the study. Second, adherence to IMT was only subjectively measured; although the 9 patients in the IMT group who developed pneumonia had trained longer than those who did not, we do not know if they truly had an effective training.

Third, the duration of mechanical ventilation was significantly shorter in the IMT group, which may have influenced the . . . [Full Text of this Article]

Stefano Nava, MD
snava@fsm.it
Fondazione S. Maugeri
Pavia, Italy

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