Questioning the role of targeted respiratory physiotherapy over and above a standard clinical pathway in the postoperative management of patients following open thoracotomy
| Autor: | Andrew Hirschhorn |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Mechanical ventilation
medicine.medical_specialty business.industry medicine.medical_treatment Pulmonary Complication Physical Therapy Sports Therapy and Rehabilitation medicine.disease Surgery law.invention Clinical trial Nursing care Clinical pathway Randomized controlled trial law medicine Physical therapy Intubation business Shoulder problem |
| Zdroj: | Journal of Physiotherapy. 57(4) |
| ISSN: | 1836-9553 1158-1166 |
| DOI: | 10.1016/s1836-9553(11)70057-1 |
| Popis: | Summary of: Reeve JC et al (2010) Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. Eur J Cardiothorac Surg 37: 1158-1166. [Prepared by Kylie Hill, CAP Editor.] Question Does routine prophylactic targeted respiratory physiotherapy after elective pulmonary resection via open thoracotomy decrease the incidence of postoperative pulmonary complications and reduce length of hospital stay? Design Randomised, controlled trial with concealed allocation in which those who collected outcome measures were blinded to group allocation. Setting Hospital ward of a tertiary referral centre in Auckland, New Zealand. Participants Adults scheduled for pulmonary resection via open thoracotomy. Exclusion criteria (i) unable to understand written and spoken English, (ii) tumour invasion of the chest wall or brachial plexus, (iii) physiotherapy for a respiratory or shoulder problem within 2 weeks prior to admission, (iv) development of a postoperative pulmonary complication prior to randomisation on Day 1 postoperatively, or (v) intubation and mechanical ventilation ≥ 24 hours following surgery. Randomisation of 76 patients allocated 42 to the intervention group and 34 to the control group. Interventions Both groups received usual medical and nursing care via a standardised clinical pathway, which included early and frequent position changes, sitting out of bed on the first postoperative day, early ambulation and frequent pain assessment. In addition, the intervention group received daily targeted respiratory physiotherapy, which comprised deep breathing and coughing exercises, assistance with ambulation, and progressive shoulder and thoracic cage exercises. Outcome measures The primary outcome was incidence of postoperative pulmonary complications, defined using a standardised diagnostic tool. The secondary outcome was the length of hospital stay. Results The primary and secondary outcomes were available for all enrolled patients. Neither the incidence of postoperative pulmonary complications [mean difference intervention-control 1.8% (95% CI -10.6 to 13.1%)] nor the hospital length of stay [intervention group median 6.0 days, control group median 6.0 days; p=0.87) differed significantly between groups. The overall incidence of postoperative pulmonary complications (3.9%) was lower than expected. Conclusion In adults following open thoracotomy, the addition of targeted respiratory physiotherapy to a standardised clinical pathway that included early mobilisation did not reduce the incidence of postoperative pulmonary complications or change length of hospital stay. |
| Databáze: | OpenAIRE |
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