Role of rehab on PPC prevention

www.bvdaihoc.com.vn ROLES OF REHABILITATION ON THE PREVENTION OF POSTOPERATIVE PULMONARY COMPLICATIONS BS Nguyễn Đức Thành Khoa Phục hồi chức Definition  Postoperative pulmonary complication (PPC) • Pulmonary abnormality occur during postoperative period • Result in clinically significant disease or dysfunction Dewi Nurul Makhabah, Multidisciplinary Respiratory Medicine , Peri-operative physiotherapy, 2013 Incidence  Postoperative pulmonary complication (PPC) • Range from 41 and 47% increase in cost, respectively A Miskovic and A B Lumb, Postoperative pulmonary complications, British Journal of Anaesthesia, 118 (3): 317–34 (2017) Risk factors of PPC • • • • • Advanced age Smoking Malnutrition Obesity Lung and other chronic diseases (liver, heart) • Preoperative SpO2 laparoscopy • Duration of surgery >2 h • Emergency surgery • Effects of anesthetic drugs on respiratory system A Miskovic and A B Lumb, Postoperative pulmonary complications, British Journal of Anaesthesia, 118 (3): 317– 34 (2017) Mechanism of PPCs • Decrease in lung volumes and capacities • Abnormal respiratory pattern • Abnormal gas exchange • Pulmonary defense in patients undergoing surgery: start with anesthetic induction and perpetuate in postop period Souza Possa, Portuguese journal of pulmonology, Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay, 2014 Mechanism of PPCs  Diaphragmatic dysfunction caused by • Trauma from manipulation close to the diaphragm • Reflex inhibition of afferent abdominal receptors • Postoperative pain Souza Possa, Portuguese journal of pulmonology, Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay, 2014 Roles of rehabilitation • • • • • Prevent and treat PPCs Reduce prevalence of difficult weaning Decrease length of ICU stay Shorten patient’s recovery period Improve QoL, health status and general conditions Dewi Nurul Makhabah, Multidisciplinary Respiratory Medicine , Peri-operative physiotherapy, 2013 Roles of rehabilitation  Pulmonary PT • Thoracic expansion exercises • Diaphragmatic breathing exercises • Incentive spirometry • Continuous positive airway pressure (CPAP) —> improve oxygenation without triggering increase in pain or other complications, lower frequency PPCs Roles of rehabilitation  Early mobilization and muscle training • Prevent PPCs • Improve functional outcomes, cognitive and respiratory conditions • Reduce risk of DVT • Reduce need of painkillers • Avoid neuromuscular complications • Enhance recovery Dewi Nurul Makhabah, Multidisciplinary Respiratory Medicine , Peri-operative physiotherapy, 2013 Roles of rehabilitation  Neuromuscular electrical stimulation • Induce changes in muscle function without any form of ventilatory stress • Easily performed in ICU, applied to thigh muscles Dewi Nurul Makhabah, Multidisciplinary Respiratory Medicine , Peri-operative physiotherapy, 2013 Evidences Evidences Evidences Evidences Evidences Evidences Evidences Evidences Evidences Evidences