Nowadays, heart and lung diseases are being diagnosed in the people from various parts of the world in large numbers, primarily due to the poor lifestyle and diet. Cholesterol-rich food and tobacco consumption also play a vital role in increasing the risk of cardiothoracic diseases. Heart diseases are the most common cause of death at present across the globe. Much importance is given to preventing the coronary artery disease and the role of the physiotherapy is being established in preventing coronary artery disease.
Owing to the improved medical care facilities subject to coronary disease are effectively managed by open – heart surgery and the role of physiotherapy in post-operative care is well established. The existing literature reveals that most of the patient develops atelectasis during the major surgeries because of general anaesthesia. 1st to 3 rd postoperative day vital capacity of the lung reduces to 66%. Physiotherapy becomes mandatory in preventing and managing postoperative pulmonary complication especially in the subject undergoing cardiac surgeries with risk factors.
The physiotherapy programme in managing the post-cardiac surgery patient focuses on the following:
- Prevent complication
- Assist in early recovery
- Reducing ventilator dependency
- Preventing immobilization complication
- Early rehabilitation
- Improve quality of life
Immediate postoperative physiotherapy care aims to prevent and manage pulmonary complication by:
- Preventing and clearing airway secretions
- Prevent and manage atelectasis
- Prevent pneumonia
- Assist in weaning
- Reduce the ventilator dependency
- Promote early mobilization
Subjects with the underlying respiratory disorder like COPD, Asthma and other respiratory are vulnerable to develop postoperative complication due to altered airway function and mucociliary action. General anaesthesia and artificial ventilation will also lead to thick airway secretions, which may obstruct the airway. Pain due to incision will affect the coughing mechanism by reducing the depth of breathing. The therapist is aware of mechanism and will make a clinical decision.
Physiotherapy techniques used to clear airway secretions include supported cough, postural drainage therapy, the Active cycle of breathing techniques and positive expiratory technique.
Bed rest is not benign. It is documented in the literature that bed rest affects all the system and as a movement, experts in the cardiac care team therapist should understand the effect of immobilization on skeletal muscle.
Effect of immobilization on skeletal muscle.
Effect of early mobilization on postoperative pulmonary complication
- Improves pulmonary function
- Increase lung volumes and capacities
- Optimizes ventilation-perfusion match
- Improves airway clearance
- Prevents immobilization complication
- Improves consciousness and psychological status
- Improves functional independence
P.S- Early mobilization chest physiotherapy is proven safe and highly effective in preventing postoperative pulmonary complication, the patient with stable hemodynamic and respiratory parameters can be mobilized by the 1st postoperative day by using gradual incremental protocol.