1
|
Jonsson M, Westerdahl E, Reeve J. Physiotherapy provided for patients undergoing thoracic surgery in Sweden - a national survey of practice. Physiother Theory Pract 2024; 40:2179-2185. [PMID: 37450405 DOI: 10.1080/09593985.2023.2233596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Patients undergoing thoracic surgery commonly receive perioperative physio-therapy, typically consisting of education, mobilization, breathing exercises, and mobility exercises. To date, no study has described physiotherapy practice for patients undergoing thoracic surgery in Sweden. PURPOSE To investigate physiotherapy interventions for patients undergoing thoracic surgery in Sweden. METHODS All physiotherapists currently working in thoracic surgery units in Sweden (n = 8) were eligible to participate. A survey was e-mailed to the physiotherapists, to determine physiotherapy interventions offered to patients undergoing thoracoscopy or open thoracic surgery. Of 21 physiotherapists, 13 (62%) responded, representing seven hospitals. RESULTS Physiotherapists reported routinely providing preoperative education and postoperative treatment for all patients undergoing thoracic surgery. Breathing exercises and mobilization were usually initiated on the day of surgery or the first postoperative day. Common treatments were deep breathing exercises, with or without positive expiratory pressure, and airway clearance techniques. Upper limb and shoulder exercises were typically initiated on the first or second day after surgery. The most important factor reported to influence treatment choice was personal experience of the attending physiotherapist. No routine post-discharge rehabilitation was provided. CONCLUSION Physiotherapists in Sweden reported routinely treating patients scheduled for thoracic surgery, both pre and postoperatively. Prehabilitation or post-discharge rehabilitation was not routinely provided.
Collapse
Affiliation(s)
- Marcus Jonsson
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Elisabeth Westerdahl
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Center, Örebro, Sweden
| | - Julie Reeve
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, AUT University, Northcote, Auckland, New Zealand
| |
Collapse
|
2
|
Leivaditis V, Skevis K, Mulita F, Tsalikidis C, Mitsala A, Dahm M, Grapatsas K, Papatriantafyllou A, Markakis K, Kefaloyannis E, Christou G, Pitiakoudis M, Koletsis E. Advancements in the Management of Postoperative Air Leak following Thoracic Surgery: From Traditional Practices to Innovative Therapies. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:802. [PMID: 38792985 PMCID: PMC11123218 DOI: 10.3390/medicina60050802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
Background: Postoperative air leak (PAL) is a frequent and potentially serious complication following thoracic surgery, characterized by the persistent escape of air from the lung into the pleural space. It is associated with extended hospitalizations, increased morbidity, and elevated healthcare costs. Understanding the mechanisms, risk factors, and effective management strategies for PAL is crucial in improving surgical outcomes. Aim: This review seeks to synthesize all known data concerning PAL, including its etiology, risk factors, diagnostic approaches, and the range of available treatments from conservative measures to surgical interventions, with a special focus on the use of autologous plasma. Materials and Methods: A comprehensive literature search of databases such as PubMed, Cochrane Library, and Google Scholar was conducted for studies and reviews published on PAL following thoracic surgery. The selection criteria aimed to include articles that provided insights into the incidence, mechanisms, risk assessment, diagnostic methods, and treatment options for PAL. Special attention was given to studies detailing the use of autologous plasma in managing this complication. Results: PAL is influenced by a variety of patient-related, surgical, and perioperative factors. Diagnosis primarily relies on clinical observation and imaging, with severity assessments guiding management decisions. Conservative treatments, including chest tube management and physiotherapy, serve as the initial approach, while persistent leaks may necessitate surgical intervention. Autologous plasma has emerged as a promising treatment, offering a novel mechanism for enhancing pleural healing and reducing air leak duration, although evidence is still evolving. Conclusions: Effective management of PAL requires a multifaceted approach tailored to the individual patient's needs and the specifics of their condition. Beyond the traditional treatment approaches, innovative treatment modalities offer the potential to improve outcomes for patients experiencing PAL after thoracic surgery. Further research is needed to optimize treatment protocols and integrate new therapies into clinical practice.
Collapse
Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, 67655 Kaiserslautern, Germany; (V.L.); (M.D.); (A.P.)
| | - Konstantinos Skevis
- Department of Thoracic Surgery, General Hospital of Rhodos, 85133 Rhodos, Greece;
| | - Francesk Mulita
- Department of General Surgery, Patras University Hospital, 26504 Patras, Greece;
| | - Christos Tsalikidis
- Second Department of Surgery, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.)
| | - Athanasia Mitsala
- Second Department of Surgery, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.)
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, 67655 Kaiserslautern, Germany; (V.L.); (M.D.); (A.P.)
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany;
| | - Athanasios Papatriantafyllou
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, 67655 Kaiserslautern, Germany; (V.L.); (M.D.); (A.P.)
| | - Konstantinos Markakis
- Department of Cardiothoracic Surgery, General Hospital of Nicosia, 2031 Nicosia, Cyprus;
| | - Emmanuel Kefaloyannis
- Department of Thoracic Surgery, University Hospital of Heraklion, 71500 Heraklion, Greece;
| | - Glykeria Christou
- Department of Thoracic Surgery, KAT Attica General Hospital, 14561 Athens, Greece;
| | - Michail Pitiakoudis
- Second Department of Surgery, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.)
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, Patras University Hospital, 26504 Patras, Greece;
| |
Collapse
|
3
|
Muelas-Gómez L, Martínez-Gimeno L, Escudero-Gómez C, Atin Arratibel MÁ, Cebrià i Iranzo MA, Solís-Muñoz M. [Efficacy of Physiotherapy Interventions on the Respiratory Musculature Through Respiratory Training Techniques in Post-operative Lung Transplant Recipients: Systematic Review]. OPEN RESPIRATORY ARCHIVES 2024; 6:100288. [PMID: 38274199 PMCID: PMC10809207 DOI: 10.1016/j.opresp.2023.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/09/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Respiratory muscles are a limiter of exercise capacity in lung transplant patients. It is necessary to know the effectiveness of specific respiratory muscle training techniques carried out in the management of adult lung transplant patients in the postoperative period. Methodology A systematic review of clinical trials was carried out, which included adult lung transplant patients undergoing post-transplant respiratory training. A search was carried out in the databases PubMed/Medline, EMBASE, Scopus, Web of Science, Cochrane Library between January 2012 and September 2023, using the terms: "breathing exercise", "respiratory muscle training", "inspiratory muscle training", "respiratory exercise", "pulmonary rehabilitation", "lung rehabilitation"; in combination with "lung transplantation", "lung transplant", "posttransplant lung". No language limit. Results Eleven trials were included with a total of 639 patients analyzed. Most training programs begin upon hospital discharge (more than one month post-transplant), few do so early (Intensive Care Unit). The duration varies from 1-12 months post-transplant. The interventions were based on aerobic training and peripheral muscle strength. Some of them included breathing exercises and chest expansions. The most used outcome variable was submaximal exercise capacity measured with the 6-minute walk test. Conclusions Training the respiratory muscles of the adult transplant patient favors the improvement of exercise capacity and quality of life. Aerobic training, as well as strength training of the rest of the peripheral muscles, contribute to the improvement of respiratory muscles.
Collapse
Affiliation(s)
- Laura Muelas-Gómez
- Unidad de Rehabilitación Respiratoria, Servicio de Rehabilitación y Medicina Física, Hospital Universitario Puerta de Hierro Majadahonda, Grupo de Investigación en Enfermería y Cuidados de Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, España
| | - Lara Martínez-Gimeno
- Fundación San Juan de Dios, Departamento de Ciencias de la Salud, Escuela de Enfermería y Fisioterapia San Juan de Dios, Universidad Pontificia Comillas, Madrid, España
| | - Cristina Escudero-Gómez
- Servicio de Biblioteca, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, España
| | - María Ángeles Atin Arratibel
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Maria Angels Cebrià i Iranzo
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia. Servicio de Medicina Física y Rehabilitación, Hospital La Fe de Valencia. Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - Montserrat Solís-Muñoz
- Unidad de Investigación, Desarrollo e Innovación en Cuidados de Salud, Hospital Universitario Puerta de Hierro Majadahonda, Grupo de Investigación en Enfermería y Cuidados de Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, España
| |
Collapse
|
4
|
Lähteenmäki SI, Sioris T, Mahrberg HSS, Rinta-Kiikka IC, Laurikka JO. A randomized trial comparing inspiratory training and positive pressure training in immediate lung recovery after minor pleuro-pulmonary surgery. J Thorac Dis 2021; 13:4690-4702. [PMID: 34527310 PMCID: PMC8411129 DOI: 10.21037/jtd-21-473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/21/2021] [Indexed: 11/12/2022]
Abstract
Background Two respiratory physiotherapy modalities were compared in a randomized controlled trial on patients undergoing minor pleuro-pulmonary surgery. Methods Forty-five patients were randomly allocated into positive expiratory pressure (PEP) therapy (n=23) and inspiratory muscle training (IMT) groups (n=22). Individualized group specific physiotherapeutic guidance was administered preoperatively, and once a day postoperatively. Patients also performed independent exercises and kept a logbook. Pain was assessed on a numerical reference scale (NRS). Volumetric pulmonary function values and walking distance were recorded preoperatively, and on first (POD1) and second postoperative days (POD2). Pre- and postoperative values were compared using two-way repeated measures analysis of variance. Results Patient characteristics and pleuro-pulmonary interventions were similar between the groups. Thoracotomy was performed in 14/45 and video assisted surgery (VATS) in 31/45 of cases. Preoperative volumetric pulmonary functions were normal or slightly decreased in 29/45, and fell significantly (P<0.001) on the first postoperative day (POD1) and improved but remained significantly lower on the second postoperative day. The recovery of mean FEV1, FIV1 and FIVC values was greater in the IMT than in the PEP group between POD1 and POD2, but without significant difference. The corresponding relative to preoperative values were higher in the IMT group, with a significant difference in FEV1 (P=0.045). Also relative PEF and FIV1 values seemed to be slightly higher in the IMT compared to the PEP group, but not significantly. Average NRS values for pain were lower in the IMT group (P=0.010) but only on POD1. Air leak was noted in 4/45 patients, two in each group, on POD1, and two in PEP groups and one in IMT group on POD2. Mean measured walking distances between groups did not differ. Mean hospital stay was 4 days in the PEP group and 3 days in the IMT group. There was no hospital mortality. Conclusions Pulmonary function values decreased significantly after minor lung resections, supporting rehabilitative respiratory physiotherapy to avoid postoperative pulmonary complications (PPCs). Both PEP and IMT training were well tolerated and equally efficient when comparing spirometry values at three time points. IMT appeared advantageous regarding relative FEV1 recovery and immediate postoperative pain.
Collapse
Affiliation(s)
- Sabina Isabel Lähteenmäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tampere Heart Hospital, Tampere, Finland
| | | | | | - Irina C Rinta-Kiikka
- Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Jari O Laurikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tampere Heart Hospital, Tampere, Finland
| |
Collapse
|