Physical Therapy Management for Adult Patients Undergoing Cardiac Surgery: A Canadian Practice Survey

Abstract

Purpose: To determine current Canadian physical therapy practice for adult patients requiring routine care following cardiac surgery. Methods: A telephone survey was conducted of a selected sample (n ¼ 18) of Canadian hospitals performing cardiac surgery to determine cardiorespiratory care, mobility, exercises, and education provided to patients undergoing cardiac surgery. Results: An average of 21 cardiac surgeries per week (range: 6-42) were performed, with an average length of stay of 6.4 days (range: 4.0-10.6). Patients were seen preoperatively at 7 of 18 sites and on postoperative day 1 (POD-1) at 16 of 18 sites. On POD-1, 16 sites performed deep breathing and coughing, 7 used incentive spirometers, 13 did upper-extremity exercises, and 12 did lower-extremity exercises. Nine sites provided cardiorespiratory treatment on POD-3. On POD-1, patients were dangled at 17 sites and mobilized out of bed at 13. By POD-3, patients ambulated 50-120 m per session 2-5 times per day. Sternal precautions were variable, but the lifting limit was reported as ranging between 5 lb and 10 lb. Conclusions: Canadian physical therapists reported the provision of cardiorespiratory treatment after POD-1. According to current available evidence, this level of care may be unnecessary for uncomplicated patients following cardiac surgery. In addition, some sites provide cardiorespiratory treatment techniques that are not supported by evidence in the literature. Further research is required. RÉ SUMÉObjectif : É tablir en quoi consiste la pratique actuelle en physiothé rapie au Canada pour les patients adultes qui ont besoin de soins intermé diaires à la suite d'une chirurgie cardiaque. Mé thodes : Un sondage té lé phonique a é té ré alisé auprè s d'un é chantillon choisi d'hô pitaux canadiens (n ¼ 18) afin de ré pertorier les soins cardiorespiratoires et pour la mobilité , les exercices et la ré adaptation offerts aux patients qui subissent une chirurgie cardiaque. Ré sultats : En moyenne, 21 chirurgies cardiaques par semaine (entre 6 et 42 interventions) ont é té pratiqué es dans les é tablissements sondé s et ces interventions ont occasionné des sé jours à l'hô pital d'une moyenne de 6,4 jours (de 4,0 à 10,6 jours par é tablissement). Les patients é taient vus de fac¸on proactive dans 7 des 18 hô pitaux sondé s et au premier jour de la pé riode postopé ratoire (JPP-1) dans 16 des 18 hô pitaux. Au JPP-1, 16 é tablissements ont demandé au patient de prendre de grandes respirations et de tousser, 7 ont utilisé des spiromè tres incitatifs, 13 ont procé dé à des exercices des membres supé rieures et 12 à des exercices des membres infé rieurs. Neuf sites ont offert des soins cardiorespiratoires au jour 3. Au jour 1, les patients é taient aidé s à s'asseoir et à se redresser dans 17 hô pitaux, et mobilisé s hors de leur lit dans 13 é tablissements. Au jour 3 aprè s l'intervention, les patients marchaient de 50 à 120 m, de 2 à 5 fois par jour. Les mesures de pré cautions sternales variaient selon les cas, mais la limite de charge dé c...

Patient participation in pulmonary interventions to reduce postoperative pulmonary complications following cardiac surgery

“…7 In recent years, the benefit of performing prophylactic, voluntary, pulmonary exercises has been questioned from a physiological perspective, [8][9][10] however deep breathing and coughing exercises remain a common respiratory intervention following cardiac surgery. [11][12][13] Findings of a recent study suggest use of a standardised postoperative care program emphasising patient education, early mobilisation and pulmonary interventions, reduced the incidence of postoperative pneumonia and unplanned intubation of patients. 14 The performance of pulmonary interventions including deep breathing and coughing exercises requires patient participation yet patients' ability and willingness to participate in pulmonary interventions is unclear.…”

“…14 The performance of pulmonary interventions including deep breathing and coughing exercises requires patient participation yet patients' ability and willingness to participate in pulmonary interventions is unclear. Further it is not known how nurses facilitate deep breathing and coughing exercises though it is clear that explaining their importance, ensuring correct technique, and providing adequate pain relief [11][12][13] are vital related activities.…”

Phase-I cardiac rehabilitation practices among physiotherapists in INDIA - A survey

“…1 The treatment is initiated after extubating the patients in ICU and it is continued in the acute wards until the patients get discharged. [2] The physiotherapy treatment given during hospital stay generally consists of exercisesfor relaxation, chest expansion; breathing exercises, cough and huff techniques, postural drainage therapy, walking and stair climbing. [1][2][3][4] The progressive ambulation and education to prepare thembefore returning home is part of acute physiotherapy management.…”

Assess the effectiveness of deep breathing exercise with incentive spirometry on respiratory status of patients who undergone cardiothoracic surgery

“…Post surgery physiotherapy techniques comprise early ambulation, positioning, deep breathing exercises, effective and coughing technique, active cycle of breathing technique (ACBT) and utilize of a variety of mechanical devices such as incentive spirometer (10)(11)(12). The purposes of physiotherapy are to enhance ventilation-perfusion matching, increase lung volume, improve mucociliary clearance, reduce pain and assist in sputum clearance and subsequently decrease arterial hypoxaemia.…”