Pulmonary Physiotherapy Research Articles

Preoperative exercise therapy for elective major abdominal surgery: A systematic review

ObjectivesThe impact of postoperative complications after Major Abdominal Surgery (MAS) is substantial, especially when socio-economical aspects are taken into account. This systematic review focuses on the effects of preoperative exercise therapy (PEXT) on physical fitness prior to MAS, length of hospital admission and postoperative complications in patients eligible for MAS, and on what is known about the most effective kind of exercise regime. MethodsA systematic search identified randomised controlled trials on exercise therapy and pulmonary physiotherapy prior to MAS. The methodological quality of the included studies was rated using the ‘Delphi List For Quality Assessment of Randomised Clinical Trials’. The level of agreement between the two reviewers was estimated with Cohen's kappa. ResultsA total of 6 studies were included, whose methodological quality ranged from moderate to good. Cohen's kappa was 0.90. Three studies reported on improving physical fitness prior to MAS with the aid of PEXT. Two studies reported on the effect of training on postoperative complications, showing contradictory results. Three studies focused on the effect of preoperative chest physiotherapy on postoperative lung function parameters after MAS. While the effects seem positive, the optimal training regime is still unclear. ConclusionPreoperative exercise therapy might be effective in improving the physical fitness of patients prior to major abdominal surgery, and preoperative chest physiotherapy seems effective in reducing pulmonary complications. However consensus on training method is lacking. Future research should focus on the method and effect of PEXT before high-risk surgical procedures.

Community acquired methicillin resistant Staphylococcus aureus pneumonia presenting along with multiple subcutaneous abscesses

Community onset necrotizing pneumonia due to community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is an emerging clinical entity, especially, following a viral infection, with substantial morbidity and mortality and survivors, have long-term pulmonary complications requiring treatment. The infectious diseases society of America guidelines has recently addressed the issue of MRSA as a possible pathogen that warrants empiric antibiotic therapy for community-acquired pneumonia (CAP) in patients requiring inpatient intensive care unit treatment, recommending the use of vancomycin or linezolid, with linezolid having an advantage due to its documented suppression of panton valentine leukocidin toxin production in CA-MRSA. We report a case of a child presenting with pyothorax and multiple subcutaneous absceses over the deltoid region. The pus from the abscesses and pyothorax and the expectorated sputum showed the growth of MRSA. The case was diagnosed as CA-MRSA pneumonia and was successfully treated with vancomycin but the patient required pulmonary decortications and long-term physiotherapy. The case highlights the importance of considering CA-MRSA in the initial empirical therapy for severe CAP and the long-term morbidity associated with this otherwise fatal disease.

Aspiration lung disorders in bovines: A case report and review

Lung aspiration disorders in bovines are invariably diagnosed as infectious aspiration pneumonias. There is a distinct differentiation between aspiration pneumonia and aspiration pneumonitis in humans that can be applied to bovines. The nature and quantity of the aspirate can result in differing pathogeneses which can require differing therapeutic approaches. Whilst blood gases were important in detecting and prognosticating lung problems, changes in barometric pressure with altitude have to be considered when interpreting partial pressures of oxygen. Anatomical differences in the lungs of bovines can explain why this species is more prone to certain pneumonic problems. Pulmonary physiotherapy is important in treating lung disorders in humans and should be considered as an adjunct therapy in bovine respiratory conditions. A case work-up was used to highlight some of the points discussed in this article.

Application of quantify pulmonary physical therapy in patients with severe acute pancreatitis and acute lung injury

Objective To explore the effect of quantify physical therapy on treating acute lung injury patients with severe acute pancreatitis.Methods Selected 112 severe acute pancreatitis cases with acute lung injury staying in our ICU from January 2010 to October 2011.Based on traditional pulmonary physical therapy,used the strengthen,accurate and quantitative pulmonary physical therapy procedures such as three steps of shrinkage lip breathing method,four steps of effective cough method,five steps of effective knock back method,Six steps of atomization inhalation,blowing balloons,continuous add humidity change oxygen therapy and so on.Then,compared the rate of endotracheal intubation,oxygenation index and ICU stay time.Results After the intervention,the rate of endotracheal intubation was 7.14％ (8/112),and the ICU stay time was ( 10.00 ±7.85) days,significantly decreased than that of the traditional therapy.Conclusions Quantify physical therapy is one of effective methods to treat acute lung injury patients with severe acute pancreatitis. Key words: Severe acute pancreatitis; Acute lung injury; Lung nursing; Pulmonary physical therapy

Guest Editorial: Physical Therapy in Critical Care

The role of physical therapists in critical care has been evolving. Of interest to this section, traditional PT care in the ICU focused on interventions for respiratory conditions, using techniques such as percussion, manual hyperinflation, suctioning, and bed exercises. As our knowledge of the importance of early mobilization has evolved, as evidenced by changes in how quickly patients are out of bed following cardiac surgery, the interventions in physical therapy have changed. The physiologic rationale for early mobilization has been discussed since the early 1990s in papers written in part by leaders in cardiovascular and pulmonary physical therapy.1 What has been lacking is strong evidence of the benefits of early mobilization in critically ill patients. In the past few years, the number of poster and platform sessions at the Combined Sections Meetings focused on physical therapy in critically ill patients has increased. Similarly, the number of published articles on this topic is growing. The topic for this special issue developed in response to these trends. Our call for papers resulted in a variety of manuscripts. We have a systematic review of mobilization in the ICU, which focuses on both safety and effectiveness outcomes. There is good evidence to support the effectiveness of early mobilization, even in patients on mechanical ventilation. Several interesting case examples are included that will be very useful in helping clinicians determine the types of interventions and outcomes most relevant to treating patients in ICU environments. One paper also addresses what can be done in the academic environment to prepare students for work in these complex practice environments. And, we benefit from the expertise of our colleagues in other countries; in this edition, we have examples from Turkey and Australia as well as the United States. The articles chosen for this issue illustrate several treatment trends that will help advance the work of PT in the critical care environment. One of our articles discusses the barriers to treatment of patients in the ICU. This shows us that some barriers, such as timing of medication administration, could be easily addressed, but will require the physical therapist to be committed to active mobilization of patients and demonstrate ability to communicate effectively with other members of the ICU team. Overall, there are relatively few adverse effects of early mobilization, particularly when therapists are observing the physiologic response of patients by monitoring vital signs during treatment sessions. A number of articles discussed in the systematic review provide guidelines for discontinuing treatment based on vital sign responses. This reminds us that we need increasing focus on one of the key tenets of cardiopulmonary physical therapy practice; that we are treating the patient's physiologic deficits in conjunction with movement and functional abnormalities. There is much work to be done in advancing the practice of PT in these critical care environments. What an exciting time of practice to be able to shape the interventions and influence better health outcomes for our patients!

A Cardiopulmonary Instructorʼs Perspective on a Standardized Patient Experience: Implications for Cardiopulmonary Physical Therapy Education

Standardized patients (SP) in Doctor of Physical Therapy (DPT) curricula are increasingly used for students to practice developing clinical reasoning, communication, and professional skills in an authentic learning environment. The purposes of this article are to: (1) describe an instructional model that synthesized SPs, Internet-based communities of practice, and reflection to teach clinical reasoning in DPT students; and (2) a cardiovascular and pulmonary physical therapy (CPPT) instructor's perspective on the educational process and student clinical skill development. The model, employed in a course: "Integrative Physical Therapy Practice," enabled the instructor to document student clinical performance and reasoning during an SP interaction. For students, clinical reasoning was illuminated through the model's assessment process. Data collected through the assessment process provided important feedback to the instructor on classroom instructional effectiveness. Examination of student learning experiences enabled the instructor to consider: (1) key aspects of examination and management for persons with cardiovascular or pulmonary disorders, (2) methods for visualizing clinical reasoning, (3) the impact of teaching on student learning, and (4) strategies for teaching CPPT. More research is indicated to investigate pedagogy for the development of clinical reasoning in DPT students.

Editorial: Clinical Practice Guidelines—How Do They Apply to Cardiovascular and Pulmonary Physical Therapy?

Recently, I was asked, along with our President, to represent the Cardiovascular and Pulmonary Section on a work group convened by APTA to discuss the development of Clinical Practice Guidelines (CPGs) by all specialties. In this very thought-provoking discussion, I was challenged to think about how our specialty would interact with evidence in the management of patients. While there are many guidelines for physician management of cardiovascular and pulmonary conditions such as chronic heart failure, chronic obstructive pulmonary disease, and peripheral arterial disease, these guidelines only guide part of our practice. I learned about the process of developing CPGs, in which evidence is reviewed and graded to lead to a recommendation from an expert panel. However, guidelines produced by and for physicians discount case studies and qualitative methodological studies and focus primarily on diagnosis. Physical therapy management of patients with these cardiovascular and pulmonary conditions is importantly informed by case studies and other forms of study, and diagnosis is not the sole end of our interaction with our patients. These issues highlight how our practice is different from that of physicians. So, what do CPGs mean for us? The emphasis needs to be on the clinical aspect of that term. Clinical practice is often messy and different from a research setting. (For an illustration, see the Letter to the Editor in this issue.) However, a practitioner needs to be guided by the best evidence possible. This is the challenge of developing CPGs. Thus, all types of research must be available for review when developing the guidelines. This is where journals like this one play an important role. By sharing work of all types—case studies, educational interventions, and randomized controlled trials—the full picture of practice can be seen. This issue illustrates the diversity that we strive to showcase. There are roles for all of us in the development of CPGs. Scholars need to give us evidence in many types of settings, educators need to systematically examine what and how we teach the next generation of PTs, and clinicians need to keep both groups informed of the realities of clinical practice. The process is long and takes many dedicated people to accomplish the task. So, in the near future, you may be asked to contribute to the development of CPGs for cardiovascular and pulmonary physical therapy practice. I hope you accept the challenge and help our specialty area improve.

Blood Gases Response to Different Breathing Modalities in Phase I of Cardiac Rehabilitation Program after Coronary Artery Bypass Graft

Aim: One major cause of postoperative respiratory complications is pulmonary atelectasis. Atelectasis and the associated loss of functional alveolar units has been recognized as a major pathophysiological mechanism responsible for postoperative hypoxemia after coronary artery bypass graft (CABG). The aim of this study was to determine which therapeutic breathing method from incentive spirometry (IS), non-invasive intermittent positive pressure breathing (IPPB) and continuous positive airway pressure breathing (CPAP) in addition to postoperative pulmonary physiotherapy obtain the best improvement in blood gases in phase I of cardiac rehabilitation program after CABG. Method: Thirty six patients of both sexes who underwent CABG divided into three groups. Group (A) received breathing training with IS (5 minutes 5 times per day) in addition the chest physiotherapy program for patients after CABG and Group (B) received breathing training with CPAP (10 cmH2O for 15 minutes once daily) in addition to the chest physiotherapy program for patients after CABG., where Group(C) received breathing training with IPPB (maximum 15 cmH2O for 15 minutes once daily) in addition to the chest physiotherapy program for patients after CABG. Measurements of blood gases were done before the study in the first post operative day and repeated at the end of the study in the tenth postoperative day. Result: Blood gases were improved in all groups in addition to a significant difference between IS & CPAP and IS & IPPB groups. Where there was no significant difference between CPAP & IPPB groups. Conclusion: Incentive spirometry in addition to the usual respiratory physical therapy is recommended for patients in phase I of cardiac rehabilitation program after CABG.

The Use of Health Related Quality of Life Measurement in Cardiovascular and Pulmonary Physical Therapy Practice: An Exploratory Study

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommends health related quality of life (HRQL) measurement with all cardiovascular and pulmonary patients. The current pattern of use of HRQL measurement among cardiovascular and pulmonary physical therapists is unknown. The purpose of this study was to evaluate the pattern of use of HRQL measurement among cardiovascular and pulmonary physical therapists. The study used a semi-structured interview format within the context of 3 focus groups. Eleven physical therapists participated in this study and all were members of the Cardiovascular and Pulmonary Section of the American Physical Therapy Association (APTA). Participants participated in a conference call and were provided a question tree to guide discussion. Several primary themes emerged, including decreased knowledge, barriers, and poor indicators of patient status. In addition, several subthemes developed including lack of familiarity, lack of use, administrative and cost limitations, inappropriateness of tool for patient population, correlation between function and quality of life, and suggestions for future outcome measures. A lack of familiarity and use of HRQL measurement and barriers to their use were established. In addition, ideas for future research on HRQL measurements with specific patient populations in physical therapy practice were defined.

Could pulmonary postoperative physiotherapy really change postoperative morbidity?

It is correct that the bicuspid aortic valve is associated with aortic dilatation in a relevant proportion of individuals. It appears overly simplistic to relate the aortopathy to flow turbulence; genetic factors seem to play a more dominant role [2]. We do agree that aortic dilatation, if present, requires correction, as we have previously pointed out [3]. It seems very hypothetical that a very liberal use of vascular grafts results in improved event-free survival. This will have to be carefully studied first, weighing risks and benefits. Plication of prolapsing cusps is only one of several possible techniques [4]. On the other hand, we have found it to be simple, reproducible and durable [5]. In summary, we appreciate interest and comments in this new and growing area of cardiac surgery.

A Systems View of Physical Therapy Care: Shifting to a New Paradigm for the Profession

Physical therapist management of patients who are acutely ill is receiving increased attention. This year, 2 observational and descriptive studies were published that report on the utilization of physical therapy in the acute care setting.1,2 This attention is timely as health care reform is debated and changes are proposed to current care delivery. As Jette et al2 state, the advent of bundled payments, or reimbursement based on the entire episode of care, will test not only the profession of physical therapy, but every profession providing care in the acute care setting and on through all care settings, including the home. All health care professions will have to adequately describe and quantify current practice, establish more robust outcome measures, and perform research to understand optimal or preferred practice as it relates to patient outcome. Physical therapists have a long history of treating people in acute care settings, and there is evidence that physical therapy intervention can make a positive difference. For example, a landmark study in 1954 defined the abnormality (postoperative pulmonary complications), divided a relatively large patient cohort (172 patients who had undergone upper-abdominal surgery) into 3 intervention groups, and measured significant decreases in the complication rate with one preferred physical therapy approach.3 Those patients who received both preoperative and postoperative pulmonary physical therapy had a 12% incidence of pulmonary complications, compared with those who received only postoperative pulmonary physical therapy (27% incidence of pulmonary complications) and those who received usual care (42% incidence of pulmonary complications). Postoperative complications for patients who had undergone upper-abdominal surgery were a major cause of morbidity and mortality in the 1950s. The reasons for …

Perioperative management of coronary artery bypass grafting

Objective To review curative effect of coronary artery bypass grafting(CABG).Methods 10 patients are off-pump CABG at normal body temperature.The rest 222 were done with CPB under general anesthesia,hypothermia.Before operation cardiopulmonary function Was adjusted.During operation the function of heart,brain and renal Was carefully protected.After operation blood slucose was controlled,inflammation was prevented and pulmonary physical therapy was given to all patients.Results 226 patients discharged recovery and free of angina pectoris completely.3 patients with CABG died of low cardiac output after operation.1 patient died of effects of protamine allergy.2 patients died of multiple organ failure.Follow-up has been done in 211 patients for 2 months to 3 years,all leading normal life and working.Conclusion Careful and standardized preoperative and pefioperative treatment is one of the factors of SUCCeSSful coronary artery bypass grafting. Key words: Coronary heart disease; Bypass grafting; Perioperative care

Cardiovascular and Pulmonary Physical Therapy Specialty Practice: Determining the Current Status

Cardiovascular and Pulmonary Physical Therapy Specialty Practice: Determining the Current Status

The efficacy of perioperative pulmonary physical therapy for patients with respiratory compromise

The efficacy of perioperative pulmonary physical therapy for patients with respiratory compromise

Verification of pulmonary physiotherapy in viewpoint of the occupational therapy

Verification of pulmonary physiotherapy in viewpoint of the occupational therapy

Renal Transplantation in a Patient Affected by Mounier-Kuhn Syndrome

Tracheobronchomegaly, also called Mounier-Kuhn syndrome, consists in dilatation of the trachea and major bronchi because of atrophy or absence of their elastic fibers and smooth muscle cells. Standard chest radiography often does not permit diagnosis because only lateral imaging, obtained with X-rays or chest CT scan, shows the true degree of tracheal dilatation. Surgery has no role in tracheomegaly, except for the complications of tracheal stenosis or pneumothorax. The present work reports cadaveric renal transplantation in a 43-year-old woman affected by end-stage renal disease and suffering from congenital tracheobronchomegaly diagnosed during the first decade of life. No surgical or anesthetic problems were encountered during the immediate perioperative period. The patient did not require pulmonary physiotherapy. Antibiotic prophylaxis was given for 10 days. No pulmonary infection developed, and the patient was discharged from the hospital asymptomatic with normal renal function at 25 days after the transplant. Four months later, the patient experienced bronchitis with cough and fever. Antibiotic therapy was performed with totally resolution of symptoms. At 8 months of follow-up after kidney transplantation, the patient is asymptomatic with normal renal function.

Cardiovascular and Pulmonary Physical Therapy Education in the United States

Cardiovascular and Pulmonary Physical Therapy Education in the United States

Cardiovascular and Pulmonary Physical Therapy Specialty Practice: Determining the Current Status

Cardiopulmonary physical therapy was the first recognized clinical specialty within physical therapy in 1978. Since that time, clinical practice in cardiovascular and pulmonary physical therapy has changed dramatically. In order to maintain currency in this field, the American Board of Physical Therapy Specialties requires that a practice analysis be performed at least every 10 years. This paper reports the process of the most recent practice analysis in cardiovascular and pulmonary physical therapy which led to the 2007 version of the Description of Specialist Practice: Cardiovascular and Pulmonary.

Causes of death and pattern of recurrence after esophagectomy and extended lymphadenectomy for squamous cell carcinoma of the thoracic esophagus

Improved understanding of how esophageal cancer behaves following curative resection, including knowledge of other causes of death, is essential for informed decision making. The medical records of 246 consecutive patients with squamous cell carcinoma of the thoracic esophagus who had undergone esophagectomy and lymphadenectomy of the neck, chest, and abdomen that was deemed macroscopically curative, were reviewed. Patients who had had other malignancies or anticancer treatment were excluded. Median follow-up period was 1289 days (minimum, 730 days). The initial patterns of recurrence were classified as intramediastinal, hematogenous, or lymphatic. Forty-two patients died of a cause other than recurrence. The in-hospital death rate was 3.6%, and 19 patients died of pulmonary disease. Sixteen patients developed a second primary, most of which were in the upper aerodigestive tract; five of those patients died. Ninety-eight patients developed recurrence. Depth of invasion and number of nodal metastases predicted recurrence. The pattern of recurrence was intra-mediastinal, lymphatic, and hematogenous in 11, 21, and 67 patients, respectively. The patients with lymphatic recurrence survived longer than the patients with either of the other types of recurrences. Eighty-three percent of recurrences presented within 24 months. The time-to-recurrence correlated with survival after recurrence. The disease recurred earlier in patients with advanced stage than unadvanced disease at the time of esophagectomy. The time-to-recurrence, and anticancer therapy after the recurrence related to the survival. Meticulous care must be taken to detect hematogenous recurrence as early as possible so that adjuvant therapy may be started. Maintaining a good performance status permits the use of aggressive therapy should there be a recurrence. Pulmonary physiotherapy and treatment of metachronous primary tumors may improve overall survival.

The Effectiveness of Pre- and Postoperative Pulmonary Physiotherapy and a Change of Pulmonary Function

The Effectiveness of Pre- and Postoperative Pulmonary Physiotherapy and a Change of Pulmonary Function