scholarly journals The effect of incentive spirometry on pulmonary function recovery and satisfaction with physical therapy of cardiac surgery patients

2020 ◽  
Author(s):  
Volodymyr Vitomskyi ◽  
Khaled Al-Hawamdeh ◽  
Maryna Vitomska ◽  
Olena Lazarіeva ◽  
Olena Haidai
Keyword(s):  
Cardiac Surgery ◽  
Physical Therapy ◽  
Pulmonary Function ◽  
Function Recovery ◽  
Incentive Spirometry

scholarly journals Comparison of three respiratory physical therapy techniques and their impact on pulmonary function restoration among cardiac surgery patients in hospital settings

2021 ◽  
Vol 23 (4) ◽  
pp. 531-535
Author(s):  
V. V. Vitomskyi
Keyword(s):  
Cardiac Surgery ◽  
Physical Therapy ◽  
Pulmonary Function ◽  
Vital Capacity ◽  
Physical Therapist ◽  
Forced Expiratory Volume ◽  
Control Group ◽  
Therapeutic Exercises ◽  
Significant Difference ◽  
Respiratory Exercises

The aim. To compare three respiratory physical therapy techniques and their impact on pulmonary function restoration among cardiac surgery patients in hospital settings. Materials and methods. The study involved 126 patients of both sexes who were admitted for cardiac surgery. All the procedures were performed by sternotomy with cardiopulmonary bypass and cardioplegic arrest. The patients were randomly divided (with a ratio of 1:1:1 by envelope method) into the control group (CG, n = 42), incentive spirometry group (ISG, n = 42) and іnspiratory muscle training group (IMTG, n = 42). The examined patients underwent standardized physical therapy (early mobilization; therapeutic exercises; coughing). The groups varied in respiratory therapy. Patients of the ISG group performed additional respiratory exercises using a Tri-Ball respiratory exerciser (three repetitions of 10 forced, full and rapid inspirations through the respiratory exerciser under the supervision of a physical therapist; besides, they were recommended to perform 3 repetitions with 10 inspirations each hour). Patients of the IMTG group performed additional respiratory exercises using Respironics Threshold IMT breathing exerciser, received explanations and recommendations like patients of the ISG group. The pulmonary function test (PFT) was performed for the patients of all groups before the surgery and on the 7 postoperative day. Results. PFT scores did not differ statistically between the groups of patients before the surgery. The three groups of patients had a negative dynamic of all test indicators, except Tiffeneau index. The analysis of PFT final scores did not confirm a significant difference in the studied indicators among the groups: vital capacity (P = 0.599), forced vital capacity (P = 0.393), forced expiratory volume in one second (P = 0.589), peak expiratory flow (P = 0.326), forced inspiratory vital capacity (P = 0.258), peak inspiratory flow (P = 0.569). Conclusions. Statistical analysis of PFT indicators did not reveal any significant differences among the groups of cardiac surgery patients at the preoperative examination and on the 7 postoperative day, despite the differences in postoperative respiratory physical therapy.

scholarly journals THEORETICAL MODEL OF STERNUM EXTERNAL FIXATION FUNCTIONING IN PHYSICAL THERAPY OF PATIENTS FOLLOWING CARDIAC SURGERY VIA STERNOTOMY

2020 ◽  
pp. 203-209
Author(s):  
V. ‌V. Vitomskyi
Keyword(s):  
Cardiac Surgery ◽  
Theoretical Model ◽  
Pulmonary Function ◽  
External Fixation ◽  
Subcutaneous Fat ◽  
Chest Circumference ◽  
Lateral Direction ◽  
Sternal Dehiscence ◽  
Function Recovery ◽  
The Impact

Abstract. The purpose is to develop and analyze a theoretical model of sternum external fixation functioning as sternal precaution after cardiac surgery via sternotomy. Methods: theoretical modeling based on literature data. Results. The literature data, measuring the impact of sternum external fixation on the development of complications after cardiac surgery via sternotomy, do not present a proper report of the functioning mechanism or mechanical model of the interaction between the sternum and sternum external fixation. The first stage of theoretical model development included selecting the criteria based on the sternum anatomy, physiology of respiration, results of scientific research, which enabled to define key aspects of the theoretical model.The second stage included studying interaction of non-elastic SEF and sternum during a deep breath and a cough acting as main elements of inspiratory muscle training after cardiac surgeries; performing a similar algorithm of studying elastic type of SEF, which enabled to investigate and analyze preventive potential of SEF in relation to sternal dehiscence in the lateral direction. The third stage included the analysis of SEF restricting potential for anteroposterior stabilisation of the sternum. Since the use of sternum external fixation should not impede pulmonary function recovery after cardiac surgery and cannot restrict chest circumference increase with inhalation, sternum external fixation cannot properly function as sternal precaution when chest circumference is increased due to sternal edge dehiscence as well. The restricting effect of inelastic sternum external fixation will be possible only in case of a large dehiscence, when its size is bigger than the chest circumference increase during normal and deep breathing. Only when the circumference of inelastic sternum external fixation corresponds to the chest circumference after a full exhalation, the effect restricting dehiscence development will be possible. However, this condition is not practically feasible and does not comply with the need for pulmonary function recovery. As an example a barrel with iron rings that prevent it from expanding and emerging of dehiscence between the boards. However, this is not practically possible and is inconsistent with physiology of respiration. The restricting effect of elastic sternum external fixation will be possible in case the force of compression is greater than the force expanding the sternum during a cough, which will completely restrict inhaling and disable its practical use. The use of sternum external fixation must be biomechanically justified. The fact that the sternum is covered with soft tissues (muscles, which are joined with the bones of the sternum, shoulder blade and humerus; subcutaneous fat, which increases with excessive body weight) also reduces sternum external fixation effectiveness, as the existence of a soft and movable layer between the fixing parts and fixing means is a negative factor. On the other hand, dehiscence is a rare case among patients who do not use SEF. This confirms the priority of the sternal closure stability after sternotomy and the factors affecting it: the strength of bone tissue, the diameter of the wire, used during sternotomy, and the number of sutures. Conclusions. The theoretical model analyzed in this study confirms either the insignificant role of sternum external fixation or its complete absence in the prevention of sternal dehiscence in the lateral direction and anteroposterior displacement of sternum edges after sternotomy.

scholarly journals The Effect of Respiratory Physical Therapy on the Lеvel of Free Fluid in Pleural Cavities after Cardiac Surgery

2021 ◽  
Vol 6 (2) ◽  
pp. 189-195
Author(s):  
V. V. Vitomskyi ◽  
◽  
Keyword(s):  
Cardiac Surgery ◽  
Physical Therapy ◽  
Physical Therapist ◽  
Pairwise Comparison ◽  
Free Fluid ◽  
Negative Effect ◽  
Number Of Cycles ◽  
The Right ◽  
Previous Group ◽  
Incentive Spirometry

The purpose of the study was to investigate the effect of respiratory physical therapy on the level of free fluid in the pleural cavities after cardiac surgery. Materials and methods. The study involved 138 patients. The patients were randomly divided into three groups: control (respiratory physical therapy was limited to cough), group of incentive spirometry (in classes with a physical therapist patients performed additional 3 approaches of 10 breaths through the simulator; they received recommendations for hourly performance of a similar number of cycles of exercise), a group of patients who received additional respiratory physical therapy with positive expiratory pressure in the form of exhalation into a bottle of water through a tube (number of repetitions and recommendations are similar to those received by the previous group). All groups underwent the same protocol of mobilization and use of therapeutic physical exercises in the procedure of therapeutic gymnastics. Performing exercises with breathing simulators began on the 1st postoperative day. Results and discussion. The results of ultrasound examinations of the level of free fluid in the left and right pleural cavities, which were performed according to the postoperative protocol, were studied. The first ultrasound examination, which was analyzed, was performed on the seventh postoperative day, and in the absence of the study on this day, the data of the next study were selected with the registration of the postoperative day number. In addition, the indicators of the final studies of the level of free fluid of the pleural cavities were compared. The position of the patient during the examinations was a sitting one. Analysis of the level of pleural effusion did not establish the benefits of using additional respiratory physical therapy in both groups. The results of studies of the right pleural cavities did not differ in groups of patients, but those of the left ones differed. Conclusion. Pairwise comparison of the groups confirmed the presence of statistically worse results of examinations of the left pleural cavities in the group of incentive spirometry, as well as the absence of statistical differences between the results of the other two groups. The negative effect of incentive spirometry should be confirmed by additional studies, as its effect differed for the results of the left (negative effect) and right (no advantage) pleural cavity

Assessment of factors affecting short-term pulmonary functions following cardiac surgery: A prospective observational study

2021 ◽  
pp. 021849232110100
Author(s):  
Neetika Katiyar ◽  
Sandeep Negi ◽  
Sunder Lal Negi ◽  
Goverdhan Dutt Puri ◽  
Shyam Kumar Singh Thingnam
Keyword(s):  
Cardiac Surgery ◽  
Pulmonary Function ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Operative Morbidity ◽  
Factors Affecting ◽  
Factors Influencing ◽  
Significant Impairment

Background Pulmonary complications after cardiac surgery are very common and lead to an increased incidence of post-operative morbidity and mortality. Several factors, either modifiable or non-modifiable, may contribute to the associated unfavorable consequences related to pulmonary function. This study was aimed to investigate the degree of alteration and factors influencing pulmonary function (forced expiratory volume in one second (FEV1) and forced vital capacity), on third, fifth, and seventh post-operative days following cardiac surgery. Methods This study was executed in 71 patients who underwent on-pump cardiac surgery. Pulmonary function was assessed before surgery and on the third, fifth, and seventh post-operative days. Data including surgical details, information about risk factors, and assessment of pulmonary function were obtained. Results The FEV1 and forced vital capacity were significantly impaired on post-operative days 3, 5, and 7 compared to pre-operative values. The reduction in FEV1 was 41%, 29%, and 16% and in forced vital capacity was 42%, 29%, and 19% consecutively on post-operative days 3, 5, and 7. Multivariate analysis was done to detect the factors influencing post-operative FEV1 and forced vital capacity. Discussion This study observed a significant impairment in FEV1 and forced vital capacity, which did not completely recover by the seventh post-operative day. Different factors affecting post-operative FEV1 and forced vital capacity were pre-operative FEV1, age ≥60, less body surface area, lower pre-operative chest expansion at the axillary level, and having more duration of cardiopulmonary bypass during surgery. Presence of these factors enhances the chance of developing post-operative pulmonary complications.

scholarly journals EARLY PHYSICAL THERAPY INTERVENTION CAN REDUCE THE CHANCE OF RESPIRATORY COMPLICATIONS IN COVID-19

2020 ◽  
Vol 4 (1) ◽  
pp. 137-138
Author(s):  
Syed Alamadar Hussein ◽  
◽  
Raheela Kanwal ◽  
Huma Balqias ◽  
Usman Farooq ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Pulmonary Function ◽  
Physical Therapist ◽  
World Health ◽  
Respiratory Complications ◽  
Positive Effects ◽  
Breathing Exercises ◽  
Lung Expansion ◽  
Postural Drainage ◽  
Initial Symptoms

Since the start of 2020, a COVID-19 emerged as a new strain of Coronavirus. Initially, it affected the population of Wuhan, China and after that it outspread all over the world and was declared as a pandemic by World Health Organization on 30th January, 2020.1 It has been identified that COVID-19 can cause mild illness including common cold to more severe condition known as acute respiratory distress syndrome (ARDS), if not treated promptly.2 While people of all ages are susceptible to COVID-19, those over 60 years of age and with cardiovascular diseases along with diabetes have even more chances of becoming seriously ill Whereas children seem to be less affected.3 Currently there is no pharmacological treatment, still some antiviral drugs have been proven to be helpful along with plasma transfusion in which plasma is extracted from the blood of patient who got recovered from COVID-19 an is transfused into the patient still suffering from the said disease.4 Symptoms of respiratory complications due to this disease influence the mind of a Physical Therapist (PT). Though after discussing the maneuvers of respiratory Physical Therapy with fellow professional colleagues as well as clinicians and practically applying it on respective relatives, friends and advice seekers after getting the informed consent from them; those who started to have initial symptoms of COVID-19 before being tested positive and then later got positive. It resulted in great ease for most of them to breathe and did not led to serious respiratory complications that include dyspnea and accumulation of thick and tenacious secretions inside the lungs, which ultimately is a precursor of pneumonia. Following were the PT interventions suggested to the patients showing acute symptoms; Steam inhalation, breathing exercises and postural drainage positions were inculcated in the treatment plan and guided respectively, steam inhalation therapy is normally advised to be used as primary care in acute respiratory diseases.5 It is most commonly used therapy at home and is inexpensive, moreover it promotes self-reliance in the patients; it is used therapeutically by inhaling steam through nose so that it reaches the respiratory system.6-8 Steam inhalation helps in loosening the mucus, it opens the nasal airway passages decreases mucosal inflammation and heat can prevent replication of viruses.9 It helps to relax muscles and relieves coughing by preventing excessive dryness in the mucosal membranes.10 Moreover, breathing exercises have been reported to have beneficial effects in improving symptoms and optimizing pulmonary function in patients. Breathing programs have been reported to have positive effects in alleviating symptoms and optimizing pulmonary function in patients.11 Breathing exercises aim to improve the individuals breathing pattern and increase in lung expansion, they also enhance the performance of respiratory muscles thus leading towards increase in functional residual capacity, and inspiratory reserve volume.12 Breathing exercises reduces breathlessness, increase exercise capacity and improve overall well-being of a person 13,14,15,16 The physiological effect of breathing exercises comprises of increase in intra-bronchial pressure thus preventing the collapse of bronchi and leading towards increase in inspiratory and expiratory flow rate.13,15 It act by stimulating the autonomic system thereby promoting relaxation and in return improves the physiological parameters.16 Furthermore, body positioning improves the efficiency and effectiveness of both primary and accessory muscles of breathing leading to ease in dyspnea and reduction in work of breathing.17 These positions improve the ventilation perfusion ratio and utilize the gravity to remove secretions.18 Positioning decrease the ventilation demand resulting in longer expiratory time thereby preventing hyperinflation and ultimately resolving dyspnea.19 As a healthcare professional and specially a Physical Therapist we would like to ask the imminent researchers to fill this gap by conducting different surveys and trials. Through our experience we’ve found that the manoeuvres we applied have been very effective and improved the overall outcome of the patients suffering from COVID -19.

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