Such muscle training is indicated in all patients before CABG, especially those with impaired baseline pulmonary function. Two prospective RCTs have shown that prophylactic nasal continuous positive airway pressure after CABG improves pulmonary function and offers protection from postoperative pulmonary complications.1200,1201 However, the applicability of these results to patients with impaired pulmonary function is uncertain, because those with severe underlying lung disease and other comorbid conditions were not enrolled. Although noninvasive positive pressure ventilation may be useful in subjects with borderline pulmonary function postoperatively, its overuse should be avoided, because it may cause gastric distention, thereby increasing the risk of vomiting and aspiration. Improved lung function has been achieved with the use of high thoracic epidural anesthesia in patients undergoing CABG,36,37 but its application has been limited by con- cerns about paraspinal and epidural hemorrhage related to epidural catheter insertion. Despite some evidence that oral corticosteroids improve pulmonary function after cardiac surgery,1207,1208 their use has not been adopted widely in subjects undergoing CABG. Finally, a consistent reduction in postoperative pulmonary complications has not been shown when off-pump (as op- posed to on-pump) CABG is performed.1209 6.6. Patients With End-Stage Renal Disease on Dialysis: Recommendations Class IIb 1. CABG to improve survival rate may be reasonable in patients with end-stage renal disease undergoing CABG for left main coronary artery stenosis of greater than or equal to 50%.479 (Level of Evidence: C) 2. CABG to improve survival rate or to relieve angina despite GDMT may be reasonable for patients with end-stage renal disease with signifi- cant stenoses (>70%) in 3 major vessels or in the proximal LAD artery plus 1 other major vessel, regardless of LV systolic function.1210 (Level of Evidence: B) Class III: HARM 1. 