Preoperative physical therapy for elective cardiac surgery patients

Hulzebos, Erik H.J.; Smit, Yolba; Helders, Paul Pjm; Meeteren, N.L.U. van

doi:10.1002/14651858.cd010118.pub2

Cited by 103 publications

(94 citation statements)

References 67 publications

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“…57 Preoperative inspiratory muscle training (IMT) may also be beneficial prior to cardiac surgery, with a recent Cochrane review demonstrating that preoperative IMT +/- exercise reduced length of stay and the risk of pneumonia (RR 0.45; 95%CI 0.24-0.83) and atelectasis (0.52; 95%CI 0.32-0.87), but not mechanical ventilation >48 hours. 58 An ongoing randomized trial in cardiac surgery patients using structured exercise protocols will provide further insight into this question and help define questions of safety and “dose” of exercises. 59 …”

Section: Utility Of Frailty Assessment—“what Can We Do With This Infomentioning

confidence: 99%

Frailty, Aging, and Cardiovascular Surgery

Graham

Brown

2017

Anesthesia &Amp; Analgesia

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Older adults make up an ever-increasing number of patients presenting for surgery, and a significant percentage of these patients will be frail. Frailty is a geriatric syndrome that has been conceptualized as decreased reserve when confronted with stressors, although the precise definition of frailty has not been easy to standardize. The two most popular approaches to define frailty are the phenotypic approach and the deficit accumulation approach, although at least 20 tools have been developed, which has made comparison across studies difficult. In epidemiologic studies, baseline frailty has been associated with poor outcomes in both community cohorts and hospitalized patients. Specifically in cardiac surgery (including transcatheter valve implantation procedures), frailty has been strongly associated with postoperative mortality and morbidity, and thus frailty likely improves the identification of high-risk patients beyond known risk scores. For perioperative physicians then, the question arises of how to incorporate this information into perioperative care. To date, two thrusts of research and clinical practice have emerged: (1) preoperative identification of high risk-patients to guide both patient expectations and surgical decision-making, and (2) perioperative optimization strategies for frail patients. However, in spite of the strong association of frailty and poor outcomes, there is a lack of well-designed trials which have examined perioperative interventions with a specific focus on frail patients undergoing cardiac surgery. Thus, in many cases, principles of geriatric care may need to be applied. Further research is needed to standardize and implement feasible definitions of frailty and examine perioperative interventions for frail patients undergoing cardiac surgery.

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Section: Utility Of Frailty Assessment—“what Can We Do With This Infomentioning

confidence: 99%

Frailty, Aging, and Cardiovascular Surgery

Graham

Brown

2017

Anesthesia &Amp; Analgesia

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“…They need to determine physical fitness and activity factors in each patient to ascertain whether and when surgery is an appropriate intervention, and identify patients who may need additional necessary preventive care. Functional status can be improved by high-quality therapeutic exercise, even in the (very) old and frail [25] and even in a short timeframe like the waiting for surgery [26]. Therapeutic exercise training should be considered to improve perioperative outcomes and functional status [24].…”

Section: Modifiable Course Of Functional Status Before and After Surgerymentioning

confidence: 99%

“…atelectasis and pneumonia) and length of hospital stay in patients undergoing elective cardiac surgery [26]. In particular, preoperative inspiratory muscle training has positive effects in patients with a high risk of developing PPCs awaiting cardiac surgery [31], while its effects in relatively healthy patients are likely negligible [11].…”

Section: Therapeutic Physical Exercise Training In Cardiovascular Surmentioning

confidence: 99%

Merits of exercise therapy before and after major surgery

Hoogeboom

Dronkers

Hulzebos

et al. 2014

Current Opinion in Anaesthesiology

160

104

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Purpose of reviewAdvances in medical care have led to an increasing elderly population. Elderly individuals should be able to participate in society as long as possible. However, with an increasing age their adaptive capacity gradually decreases, specially before and after major life events (like hospitalization and surgery) making them vulnerable to reduced functioning and societal participation. Therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate.Recent findingsThere is high quality evidence that preoperative exercise in patients scheduled for cardiovascular surgery is well tolerated and effective. Moreover, there is circumstantial evidence suggesting preoperative exercise for thoracic, abdominal and major joint replacement surgery is effective, provided that this is offered to the high-risk patients. Postoperative exercise should be initiated as soon as possible after surgery according to fast-track or enhanced recovery after surgery principles.SummaryThe perioperative exercise training protocol known under the name ‘Better in, Better out’ could be implemented in clinical care for the vulnerable group of patients scheduled for major elective surgery who are at risk for prolonged hospitalization, complications and/or death. Future research should aim to include this at-risk group, evaluate perioperative high-intensity exercise interventions and conduct adequately powered trials.

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“…Korištenjem mješovitih metoda te vježbe dišnih miši-ća utvrđeno je smanjene pojavnosti ventilacijskih, ali ne i smanjene trajanja mehaničke ventilacije te nastanak pneumotoraksa [11]. U Škotskoj je postotak izvođenja operacijskog zahvata aortokoronarnog premošćenja u porastu te je istraženo mogu li se komplikacije kardiokirurškog zahvata smanjiti ili otkloniti provođenjem specifičnih edukacijskih i psiholoških intervencija.…”

Section: Rezultati/ Resultsunclassified

Coronary artery bypass grafting-factors of nursing pertinent to improve the

Mičević

Mraović

Friganović

2016

SG/NJ

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Au tor za ko res pon den ci ju/Corresponding aut hor : Adriano Friganović, mag. med. techn., HR-10090 Zagreb, Croatia, Tel.: +385 • GSM: +385 • E-mail: Received ORIGINALNI ČLANAK/ ORIGINAL ARTICLE SažetakUvod: Nove metode liječenja ishemijske bolesti srca sa sobom nose mogućnost poboljšanja kvalitete života pacijenta i smanjenje mortaliteta, no s druge strane produženje života takvih pacijenata dovodi do sve veće potrebe za zdravstvenom njegom. Postupak aortokoronarnog premoštenja danas je široko primjenjivana metoda liječenja, ali kod nekih pacijenata izaziva osjećaj straha i anksioznosti. Preoperativna priprema postupak je koji treba provesti prije samog zahvata od strane dobro educirane medicinske sestre, dajući pacijentu potrebne informacije, te na taj način smanjiti tjeskobu i umiriti pacijenta. Cilj: Cilj ovog članka bio je istražiti utjecaj preoperativne pripreme bolesnika za zahvat aortokoronarnog premoštenja na smanjenje anksioznosti i straha, prema podacima iz pretraživanih studija. Metode: PubMed baza pretraživana je s ciljem pronalaska odgovarajućih studija i članaka objavljenih u posljednjih15 godina. Korištene ključne riječi su aortokoronarno premoštenje, sestrinstvo, preoperativna priprema, intenzivna skrb. Rezultati: Tijekom pretraživanja baze pronašli smo 10 članaka, od kojih smo, prema kriterijima uključenja za ovaj rad, uporabili 5 studija. Podaci iz korištene literature pokazali su da davanje informacija pacijentima prije operativnog zahvata ima ključnu ulogu u smanjenju stresa te ublažavaju negativnih emocija. Zaključak: Preoperativna edukacija pacijenata koji čekaju na zahvat aortokoronarnog premoštenja vrlo je važan segment sestrinske skrbi, koja pacijentu osigurava psihičku pripremu kako bi što lakše prošao kroz razdoblje pripreme, a samim time povećava sigurnost pacijenta te smanjuje osjećaj straha i anksioznosti, što na kraju dovodi do prevencije mogućih postoperativnih komplikacija. Ključne riječi: aortokoronarno premoštenje • sestrinstvo • preoperativna priprema • intenzivna skrb Kratki naslov: aortokoronarna premosnica i sestrinstvo AbstractObjectives: New methods of treatment of ischemic heart disease bring the possibility of improving the quality of patients life and reduces mortality, but on the other hand extension of the life of such patients leads to the growing need for health care. The process of CABG today is widely applied method of treatment, but in some patients cause a feeling of fear and anxiety. Preoperative preparation procedure needs to be performed prior to the procedure by welleducated nurses, giving the necessary information to a patient; such preparation will reduce patient's anxiety and calm. Aim: The aim was to investigate the effect of preoperative preparation of patients for the procedure of CABG on reducing anxiety and fear, according to data from the study searched. Methods: PubMed data base was searched with the aim of finding relevant studies and articles published in the period of last 15 years. Used key words were coronary artery bypass, nursing, pr...

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Preoperative physical therapy for elective cardiac surgery patients

Cited by 103 publications

References 67 publications

Frailty, Aging, and Cardiovascular Surgery

Frailty, Aging, and Cardiovascular Surgery

Merits of exercise therapy before and after major surgery

Coronary artery bypass grafting-factors of nursing pertinent to improve the

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