Peri-operative physiotherapy

Multidisciplinary respiratory medicine (Impact Factor: 0.15). 01/2013; 8(1):4. DOI: 10.1186/2049-6958-8-4
Source: PubMed


Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care. Physiotherapy (PT) programs in post-surgical and critical area patients are aimed to reduce the risks of PPC due to long-term bed-rest, to improve the patient's quality of life and residual function, and to avoid new hospitalizations. At this purpose, PT programs apply advanced cost-effective therapeutic modalities to decrease complications and patient's ventilator-dependency. Strategies to reduce PPC include monitoring and reduction of risk factors, improving preoperative status, patient education, smoking cessation, intra-operative and postoperative pulmonary care. Different PT techniques, as a part of the comprehensive management of patients undergoing cardiac, upper abdominal, and thoracic surgery, may prevent and treat PPC such as secretion retention, atelectasis, and pneumonia.

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    ABSTRACT: This review of progress toward reliable prediction of postoperative pulmonary complications (PPCs) discusses risk assessment against the background of patient management strategies, clinical outcomes, and cost of healthcare. Among the variety of conditions grouped as PPCs are pneumonia, aspiration pneumonitis, respiratory failure, reintubation within 48 h, weaning failure, pleural effusion, atelectasis, bronchospasm, and pneumothorax. PPC incidence rates range from 2 to 40% depending on context. These events increase mortality, postoperative length of stay, ICU admissions, hospital readmissions, and costs. PPC-associated mortality varies, but can reach as high as 48% in some contexts. ICU admission rates are between 9.5 and 91% higher in patients with PPCs. The mean increase in PPC-related postoperative length of stay is approximately 8 days. The cost of surgery can be two-fold to 12-fold higher when PPCs develop. Strategies proposed to reduce the impact of modifiable risk factors include alcohol and smoking abstinence before surgery, shortening the duration of surgery, and physiotherapy and incentive spirometry techniques; however, little scientific evidence supports them at this time. PPCs are associated with a higher incidence of life-threatening events and higher costs. Reliable PPC risk-stratification tools are essential for guiding clinical decision-making in the perioperative period. The care team can act on modifiable factors and optimize vigilance over nonmodifiable ones. It would be useful to focus resources on determining whether low-cost preemptive interventions improve outcomes satisfactorily or new strategies need to be developed.
    Current opinion in anaesthesiology 01/2014; 27(2). DOI:10.1097/ACO.0000000000000045 · 1.98 Impact Factor
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    ABSTRACT: To provide an update of research findings on the mechanisms underlying respiratory complications after cardiac surgery, especially acute respiratory distress syndrome, transfusion-related lung injury and ventilation-associated pneumonia. The article will review some of the preventive and therapeutic measures that can be implemented to reduce these complications, focusing on the use of protective invasive ventilation and postextubation noninvasive ventilation. The development of postoperative pulmonary complications is related to various perioperative factors. The most effective preventive measures are a correct preoperative preparation and an uneventful surgery. The implementation of nosocomial pneumonia prevention bundles, or early extubation in a fast-track program, has proven to be effective in reducing the complication rate. The application of protective invasive ventilation, with low tidal volumes, has been found to reduce lung injury and mortality in patients with lung injury or healthy lungs. The use of noninvasive ventilation as a preventive postextubation approach in patients at risk and rescue noninvasive ventilation in those developing respiratory failure remains under debate and is subject to ongoing research. Postoperative pulmonary complications are common, but severe complications are infrequent. Their reduction requires measures to prevent infection and mechanical ventilation-associated lung injury through the use of low tidal volumes and early extubation. Noninvasive ventilation after extubation can be utilized to avoid reintubation and the associated increased morbidity and mortality. However, noninvasive ventilation should be done under rigorous conditions and by following strict criteria.
    Current opinion in anaesthesiology 02/2014; 27(2). DOI:10.1097/ACO.0000000000000059 · 1.98 Impact Factor
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