Esra Pehlivan, Arif Balcı, Feride Elçin Cagay, Z. Nilgün Ulukol

Göğüs Cerrahisi Sonrası Erken Dönemde Uygulanan Fizyoterapinin Hemodinamik Etkileri

Amaç: Çalışmamızda göğüs cerrahisi sonrası yoğun bakım ünitesinde yatmakta olan hastalarda erkendönemde uygulanan fizyoterapinin hemodinamik etkilerini belirlemek amaçlanmıştır.Gereç ve Yöntemler: Çalışmaya göğüs cerrahisi geçiren ve cerrahi yoğun bakımda 24 saatini tamamlayan toplam 72 hasta dahil edildi. Hastalara solunum egzersizleri, insentif spirometre çalışması, destekli öksürme ve mobilizasyon içerikli fizyoterapi programı, cerrahi yoğun bakım ünitesinde uygulandı.Tedaviden önce, sonra, ve 5 dakika sonra (toparlanma) sistolik (SKB) ve diyastolik (DKB) kan basıncı,kalp hızı (KH) ve oksijen satürasyonu (SpO2) ölçümleri yapıldı. Ağrı seviyesi ise Vizüel Analog Skala(VAS, 0–10) ile değerlendirildi.Bulgular: Hastaların 22’si (%30) kadın, 50’si (%70) erkek, yaş ortalaması ise 59±12,76 yıl idi. Tedavi öncesi ve sonrası ölçümlerinin karşılaştırmasında DKB’deki yükselme (p=0,006), tedavi sonrası vetoparlanma ölçümlerinin karşılaştırmasında KH’deki düşme (p=0,008), tedavi öncesi ve toparlanmaölçümlerinin karşılaştırmasında ise KH’deki düşme (p=0,026) ve DKB’deki yükselme (p=0,014) istatistiksel olarak anlamlıydı. Meydana gelen hemodinamik değişimler fizyolojik limitler içindeydi.Tartışma ve Sonuç: Çalışmamızdan elde edilen sonuçlara göre cerrahi yoğun bakım ünitesinde uygulanan erken dönem fizyoterapi güvenlidir. Fizyolojik yanıtları görmek ve hasta güvenliğini sağlamakamacıyla fizyoterapi sırasında hemodinamik parametreler sürekli izlenmelidir.

Hemodynamic Effects of Early Physiotherapy in Intensive Care Unit after Chest Surgery

Aim: This study aimed to determine the hemodynamic effects of early physiotherapy administered in patients hospitalized in the intensive care unit after chest surgery. Materials and Methods: A total of 72 patients who completed the 24-hour period after chest surgery in the surgical intensive care unit were included. The patients underwent a physiotherapy program comprising breathing exercises, incentive spirometer training, assisted coughing, and mobilization in the surgical intensive care unit. Systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR), and oxygen saturation (SpO2 ) were measured before, after, and 5 minutes (recovery) after the treatment. Pain level was assessed by the Visual Analogue Scale (VAS, 0–10). Results: Of the patients, 22 (30%) were female and 50 (70%) male, and the mean patient age was 59±12.76 years. The increase in DBP (p=0.006), decrease in HR (p=0.008), and decrease in HR (p=0.026) and increase in DBP (p=0.014) were statistically significant in the comparisons made between the measurements before and after treatment, after treatment and at recovery, and before treatment and at recovery, respectively. The hemodynamic changes were within the physiological limits. Discussion and Conclusion: According to our study results, early physiotherapy administered in the surgical intensive care unit is safe. Hemodynamic parameters should be monitored continuously during physiotherapy to observe the physiological responses and provide patient safety.

PDF

___

1. Haller G, Walder B. Postoperative pulmonary complications: still room for improvement. Eur J SAnaesthesiol. 2017;34(8):489–91.
2. Bendixen M, Jorgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol. 2016;17(6):836–44.
3. Baddeley RA. Physiotherapy for enhanced recovery in thoracic surgery. J Thorac Dis. 2016;8(Suppl 1):S107–10.
4. Naccarato M, Leviner S, Proehl J, Barnason S, Brim C, Crowley M ve ark. Emergency Nursing Resource: orthostatic vital signs. J Emerg Nurs. 2012;38(5):447–53.
5. dos Santos RS, Donadio MV, da Silva GV, Blattner CN, Melo DA, Nunes FB ve ark. Immediate effects of chest physiotherapy on hemodynamic, metabolic, and oxidative stress parameters in subjects with septic shock. Respir Care. 2014;59(9):1398–403.
6. Agostini P, Naidu B, Cieslik H, Steyn R, Rajesh PB, Bishay E ve ark. Effectiveness of incentive spirometry in patients following thoracotomy and lung resection including those at high risk for developing pulmonary complications. Thorax. 2013;68(6):580–5.
7. Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest. 2001;120(3):971–8.
8. Rupp M, Miley H, Russell-Babin K. Incentive spirometry in postoperative abdominal/thoracic surgery patients. AACN Adv Crit Care. 2013;24(3):255–63.
9. Melendez JA, Alagesan R, Reinsel R, Weissman C, Burt M. Postthoracotomy respiratory muscle mechanics during incentive spirometry using respiratory inductance plethysmography. Chest. 1992;101(2):432–6.
10. Schmidt I. [Assisted cough--physiotherapy to improve expectoration of mucus]. Pneumologie. 2008;62(Suppl. 1):S23–7.
11. Sobush DC. Is the application of external thoracic support following median sternotomy a placebo or a prudent intervention strategy? Respir Care. 2008;53(8):1010–1.
12. Hodgson CL, Berney S, Harrold M, Saxena M, Bellomo R. Clinical review: early patient mobilization in the ICU. Crit Care. 2013;17(1):207.
13. Schujmann DS, Lunardi AC, Fu C. Progressive mobility program and technology to increase the level of physical activity and its benefits in respiratory, muscular system, and functionality of ICU patients: study protocol for a randomized controlled trial. Trials. 2018;19(1):274.
14. Khan MH, Kunselman AR, Leuenberger UA, Davidson WR, Jr., Ray CA, Gray KS ve ark. Attenuated sympathetic nerve responses after 24 hours of bed rest. Am J Physiol Heart Circ Physiol. 2002;282(6):H2210–5.
15. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.
16. Castelino T, Fiore JF, Jr., Niculiseanu P, Landry T, Augustin B, Feldman LS. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: a systematic review. Surgery. 2016;159(4):991–1003.
17. Hanada M, Kanetaka K, Hidaka S, Taniguchi K, Oikawa M, Sato S ve ark. Effect of early mobilization on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic surgery on the esophagus. Esophagus. 2018;15(2):69–74.
18. Arbane G, Douiri A, Hart N, Hopkinson NS, Singh S, Speed C ve ark. Effect of postoperative physical training on activity after curative surgery for non-small cell lung cancer: a multicentre randomised controlled trial. Physiotherapy. 2014;100(2):100–7.
19. 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(12):493–8.
20. Klein P, Kemper M, Weissman C, Rosenbaum SH, Askanazi J, Hyman AI. Attenuation of the hemodynamic responses to chest physical therapy. Chest. 1988;93(1):38– 42.
21. Selwyn AP BE. Harrison’s Principles of Internal Medicine, 15. ed. Baltimore: 2001:1399–410.
22. Wong. W. Use of body positioning in the mechanically ventilated patient with acute respiratory failure: application of Sackett’s rules of evidence. Physiother Theory Pract. 2009;15(1):25–41.
23. Stiller K, Phillips, AC., P. Lambert. The safety of mobilisation and its effect on haemodynamic and respiratory status of intensive care patients. Physiother Theory Pract. 2004;20:175–85.