Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Essentials of Physiotherapy after Thoracic Surgery: What Physiotherapists Need to Know. A Narrative Review

  • Ahmad, Ahmad Mahdi (Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University)
  • Received : 2018.05.17
  • Accepted : 2018.08.16
  • Published : 2018.10.05
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Abstract

Physiotherapy has recently become an essential part of enhanced recovery protocols after thoracic surgery. The evidence-based practice of physiotherapy is essential for the effective management of postoperative patients. Unfortunately, only a small body of literature has discussed the rationale of the physiotherapy interventions that are routinely implemented following thoracic surgery. Nonetheless, we can integrate the available knowledge into our practice until new evidence emerges. Therefore, in this review, the principles of physiotherapy after thoracic surgery are presented, along with a detailed description of physiotherapy interventions, with the goals of enhancing the knowledge and practical skills of physiotherapists in postoperative care units and helping them to re-evaluate and justify their traditional practices.

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References

  1. Denehy L. Surgery for adults. In: Pryor JA, Prasad SA, editors. Physiotherapy for respiratory and cardiac problems: adults and paediatrics. 4th ed. Edinburgh: Churchill Livingstone; 2008. p. 397-436.
  2. Dyson A, Youd KL. Physiotherapy in thoracic surgery. In: Porter SB, editor. Tidy's physiotherapy. 15th ed. Edinburgh: Saunders Elsevier; 2013. p. 169-80.
  3. Bertani A, Ferrari P, Terzo D, et al. A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoraco- scopic surgery lobectomy. J Thorac Dis 2018;10(Suppl 4): S499-S511. https://doi.org/10.21037/jtd.2018.02.55
  4. Dinic VD, Stojanovic MD, Markovic D, Cvetanovic V, Vukovic AZ, Jankovic RJ. Enhanced recovery in thoracic surgery: a review. Front Med (Lausanne) 2018;5:14.
  5. Kendall F, Abreu P, Pinho P, Oliveira J, Bastos P. The role of physiotherapy in patients undergoing pulmonary surgery for lung cancer: a literature review. Rev Port Pneumol (2006) 2017;23:343-51.
  6. Pryor JA, Webber BA. Physiotherapy for respiratory and cardiac problems. Edinburgh: Churchill Livingstone; 1998.
  7. Agostini P, Lugg ST, Adams K, et al. Postoperative pulmo- nary complications and rehabilitation requirements following lobectomy: a propensity score matched study of patients undergoing video-assisted thoracoscopic surgery versus thoracotomy. Interact Cardiovasc Thorac Surg 2017;24:931-7. https://doi.org/10.1093/icvts/ivx002
  8. Agostini P, Cieslik H, Rathinam S, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax 2010;65:815-8. https://doi.org/10.1136/thx.2009.123083
  9. Novoa N, Ballesteros E, Jimenez MF, Aranda JL, Varela G. Chest physiotherapy revisited: evaluation of its influence on the pulmonary morbidity after pulmonary resection. Eur J Cardiothorac Surg 2011;40:130-4. https://doi.org/10.1016/j.ejcts.2010.11.028
  10. Li WW, Lee TW, Yim AP. Shoulder function after thoracic surgery. Thorac Surg Clin 2004;14:331-43. https://doi.org/10.1016/S1547-4127(04)00021-0
  11. Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin 2008;26:355-67. https://doi.org/10.1016/j.anclin.2008.01.007
  12. Baddeley RA. Physiotherapy for enhanced recovery in thoracic surgery. J Thorac Dis 2016;8(Suppl 1):S107-10.
  13. Freynet A, Falcoz PE. Is transcutaneous electrical nerve stimulation effective in relieving postoperative pain after thoracotomy? Interact Cardiovasc Thorac Surg 2010;10: 283-8. https://doi.org/10.1510/icvts.2009.219576
  14. Kerai S, Saxena KN, Taneja B, Sehrawat L. Role of trans- cutaneous electrical nerve stimulation in post-operative analgesia. Indian J Anaesth 2014;58:388-93. https://doi.org/10.4103/0019-5049.138966
  15. Desantana JM, Santana-Filho VJ, Sluka KA. Modulation be- tween high- and low-frequency transcutaneous electric nerve stimulation delays the development of analgesic tolerance in arthritic rats. Arch Phys Med Rehabil 2008;89:754-60. https://doi.org/10.1016/j.apmr.2007.11.027
  16. Watkins AA, Johnson TV, Shrewsberry AB, et al. Ice packs reduce postoperative midline incision pain and narcotic use: a randomized controlled trial. J Am Coll Surg 2014; 219:511-7. https://doi.org/10.1016/j.jamcollsurg.2014.03.057
  17. Chailler M, Ellis J, Stolarik A, Woodend K. Cold therapy for the management of pain associated with deep breathing and coughing post-cardiac surgery. Can J Cardiovasc Nurs 2010;20:18-24.
  18. Pepper JA, Anderson JM, Innocenti DM. Pulmonary surgery. In: Downie PA, editor. Cash' textbook of chest, heart, and vascular disorders for physiotherapists. 4th ed. London: Mosby; 1992. p. 374-85.
  19. Pryor JA, Prasad SA. Physiotherapy techniques. In: Pryor JA, Prasad SA, editors. Physiotherapy for respiratory and cardiac problems: adults and paediatrics. 4th ed. Edinburgh: Churchill Livingstone; 2008. p. 136-63.
  20. Ridely SC, Heinl-Green A. Surgery for adults. In: Pryor JA, Prasad SA, editors. Physiotherapy for respiratory and car- diac problems: adults and paediatrics. 3rd ed. Edinburgh: Churchill Livingstone; 2002. p. 377-420.
  21. Nielsen KG, Holte K, Kehlet H. Effects of posture on post- operative pulmonary function. Acta Anaesthesiol Scand 2003;47:1270-5. https://doi.org/10.1046/j.1399-6576.2003.00240.x
  22. Connors AF Jr, Hammon WE, Martin RJ, Rogers RM. Chest physical therapy: the immediate effect on oxygenation in acutely ill patients. Chest 1980;78:559-64. https://doi.org/10.1378/chest.78.4.559
  23. Naylor JM, McLean A, Chow CM, Heard R, Ting I, Avolio A. A modified postural drainage position produces less cardiovascular stress than a head-down position in patients with severe heart disease: a quasi-experimental study. Aust J Physiother 2006;52:201-9. https://doi.org/10.1016/S0004-9514(06)70029-0
  24. Gosselink R, Bott J, Johnson M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med 2008;34: 1188-99. https://doi.org/10.1007/s00134-008-1026-7
  25. Kaneda H, Saito Y, Okamoto M, Maniwa T, Minami K, Imamura H. Early postoperative mobilization with walking at 4 hours after lobectomy in lung cancer patients. Gen Thorac Cardiovasc Surg 2007;55:493-8. https://doi.org/10.1007/s11748-007-0169-8
  26. Yousef K, Pinsky MR, DeVita MA, Sereika S, Hravnak M. Characteristics of patients with cardiorespiratory instability in a step-down unit. Am J Crit Care 2012;21: 344-50. https://doi.org/10.4037/ajcc2012797
  27. Sevransky J. Clinical assessment of hemodynamically unstable patients. Curr Opin Crit Care 2009;15:234-8. https://doi.org/10.1097/MCC.0b013e32832b70e5
  28. Sciaky A, Pawlik A, Johanson M, Lahart M. Interventions for acute cardiopulmonary conditions. In: Hillegass E, editor. Essentials of cardiopulmonary physical therapy. 4th ed. St. Louis (MO): Elsevier; 2017. p. 539-60.
  29. Simmons M, Simmons P. Postoperative respiratory care. In: Hess DR, Maclntyre NR, Galvin WF, Mishoe SC, editors. Respiratory care: principles and practice. 3rd ed. Burlington (MA): Jones & Bartlett Learning; 2016. p. 921-30.
  30. Duggan M, Kavanagh BP. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology 2005;102:838-54. https://doi.org/10.1097/00000542-200504000-00021
  31. Platell C, Hall JC. Atelectasis after abdominal surgery. J Am Coll Surg 1997;185:584-92. https://doi.org/10.1016/S1072-7515(97)00106-3
  32. Main E. Physiotherapy interventions. In: Main E, Denehy L, editors. Cardiorespiratory physiotherapy: adults and paediatrics. 5th ed. Edinburgh: Elsevier; 2016. p. 266-9.
  33. Tucker B, Jenkins S. The effect of breathing exercises with body positioning on regional lung ventilation. Aust J Physiother 1996;42:219-27. https://doi.org/10.1016/S0004-9514(14)60389-5
  34. Watchie J. Cardiovascular and pulmonary physical therapy: a clinical manual. 2nd ed. St. Louis (MO): Saunders Elsevier; 2010.
  35. Levenson C. Breathing exercises. In: Zadai CC, editor. Pulmonary management in physical therapy. New York (NY): Churchill Livingstone; 1992.
  36. Pathmanathan N, Beaumont N, Gratrix A. Respiratory physiotherapy in the critical care unit. Contin Educ Anaesth Crit Care Pain 2014;15:20-5.
  37. Agostini P, Calvert R, Subramanian H, Naidu B. Is incentive spirometry effective following thoracic surgery? Interact Cardiovasc Thorac Surg 2008;7:297-300.
  38. Brocki BC, Andreasen JJ, Langer D, Souza DS, Westerdahl E. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: a randomized controlled trial. Eur J Cardiothorac Surg 2016;49:1483-91. https://doi.org/10.1093/ejcts/ezv359
  39. Scanlan CL, Heuer AJ. Comprehensive respiratory therapy exam preparation guide. 2nd ed. Burlington (MA): Jones & Bartlett Learning; 2015.
  40. Fink JB. Forced expiratory technique, directed cough, and autogenic drainage. Respir Care 2007;52:1210-21.
  41. Hess DR, MacIntyre NR, Mishoe SC, Galvin WF, Adams AB. Respiratory care: principles and practice. 2nd ed. Burlington (MA): Jones & Bartlett Learning; 2012.
  42. Frownfelter D, Dean E. Cardiovascular and pulmonary physical therapy: evidence to practice. 5th ed. St. Louis (MO): Elsevier Mosby; 2012.
  43. MacPhedran K, Hillegass E. Cardiovascular and thoracic interventions. In: Hillegass E, editor. Essentials of cardiopulmonary physical therapy. 4th ed. St. Louis (MO): Elsevier; 2017. p. 367.
  44. Kisner C, Colby LA. Surgical interventions and postoperative complications. In: Kisner C, Colby LA, editors. Therapeutic exercise: foundations and techniques. 5th ed. Philadelphia (PA): F. A. Davis Company; 2007. p. 329-48.
  45. Jones LW, Eves ND, Peterson BL, et al. Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients: a pilot study. Cancer 2008;113:3430-9. https://doi.org/10.1002/cncr.23967
  46. Stigt JA, Uil SM, van Riesen SJ, et al. A randomized controlled trial of postthoracotomy pulmonary rehabilitation in patients with resectable lung cancer. J Thorac Oncol 2013;8:214-21. https://doi.org/10.1097/JTO.0b013e318279d52a