CHEST PHYSIOTHERAPY

Chest physiotherapy is a critical component of postoperative care following cardiac or thoracic surgery. It
aims to prevent pulmonary complications, improve lung function, and facilitate recovery. The key
components and recommended practices for chest physiotherapy after such surgeries include:

Key Components of Chest Physiotherapy

1. Breathing Exercises:

 Deep Breathing Exercises: These are essential to expand lung volumes and prevent
atelectasis. Techniques may include incentive spirometry and the Active Cycle of
Breathing Technique (ACBT) which involves controlled breathing patterns to clear
secretions and enhance lung inflation .

 Coughing Techniques: Effective coughing is crucial for clearing secretions. Patients are
often instructed to use a pillow or towel to support their chest during coughing to
minimize pain .

2. Mobilization:

 Early mobilization is encouraged as it helps improve circulation and lung function.

Patients are typically assisted to sit up, stand, and walk as soon as they are stable post-
surgery .

3. Positioning:

 Proper positioning can aid in lung expansion and comfort. Patients are often advised to
sit upright or at an angle that reduces pressure on the chest

1. Chest Care Techniques:

 Techniques such as percussion and vibration may be employed to help loosen secretions
in patients with increased phlegm production .

2. Monitoring and Progression:

 Physiotherapists monitor patients' progress, adjusting exercises based on individual

recovery rates and complications that may arise post-surgery .

Recommended Practices After Cardiac or Thoracic Surgery

 Timing: Chest physiotherapy should begin within 4-12 hours after surgery, with sessions lasting
about 30 minutes, two to three times daily .

 Exercise Regimen: Patients may perform a variety of exercises including leg movements, arm
exercises, and walking programs that gradually increase in duration and intensity .

 Duration of Exercises: The frequency of breathing exercises can vary significantly, with
recommendations ranging from 4 to 30 breaths per hour during the initial postoperative days .
  Patient Education: Patients should be educated on the importance of these exercises for their
recovery, including how long to continue them after discharge .

References

1. Westerdahl, E., et al. "Chest physiotherapy after coronary artery bypass graft surgery - A
comparison of three different deep breathing techniques." Journal of Rehabilitation
Medicine (2020).

2. "Chest physiotherapy and breathing exercises for cardiac surgery." PubMed (2020).

3. "Physiotherapy for heart surgery." South Tees NHS Foundation Trust (2020).

4. "Essentials of Physiotherapy after Thoracic Surgery: What Physiotherapists Need to

Know." NCBI (2021).

5. "Physical Therapy After Heart Surgery." Cleveland Clinic Abu Dhabi (2020).

These sources provide comprehensive insights into the components and practices involved in chest
physiotherapy following cardiac or thoracic surgery, emphasizing the importance of early intervention
and tailored rehabilitation strategies for optimal recovery outcomes.

https://www.southtees.nhs.uk/resources/physiotherapy-for-heart-surgery/

### Referat on Chest Physiotherapy After Cardiothoracic Surgery

Chest physiotherapy is a crucial component of postoperative care, especially following cardiac or thoracic
surgery. The primary goals of this therapy are to prevent pulmonary complications, enhance lung
function, and expedite patient recovery. Below are the key components and recommended practices for
chest physiotherapy after such surgeries, based on valid and reliable textbooks and journals.

#### 1. **Key Components of Chest Physiotherapy**

1. **Deep Breathing Exercises**

- **Inspiratory Muscle Training**: This training can improve lung capacity and reduce the risk of
pulmonary complications (PPCs).

- **Deep Breathing Techniques**: Techniques such as using an incentive spirometer help expand lung
volumes and prevent atelectasis.
2. **Early Mobilization**

- **Early Mobilization**: Encouraging early mobilization is vital for improving blood circulation and
lung function. Patients are typically assisted to mobilize as soon as they are stable post-surgery.

3. **Coughing Techniques**

- **Effective Coughing**: Teaching effective coughing techniques is essential for clearing secretions
from the lungs. Patients are often instructed to cough while supporting their chest with a pillow or towel
to minimize discomfort.

4. **Use of Mechanical Devices**

- **Mechanical Aids**: Devices such as blow bottles may be used to assist patients in performing deep
breathing exercises more effectively.

5. **Proper Positioning**

- **Positioning**: Proper positioning can aid lung expansion and comfort. Patients are generally
advised to sit upright or at an angle that reduces pressure on the chest.

6. **Wound Support**

- **Reducing Chest Pressure**: It is important to minimize pressure on the chest to allow patients to
breathe deeply and cough comfortably. Physiotherapists may employ methods like "bear-hug"
techniques to support the incision site and any intercostal drains.

#### 2. **Recommended Practices After Cardiac or Thoracic Surgery**

1. **Initiate Therapy on the First Day**

- Chest physiotherapy should begin within the first day post-surgery. Patients who develop "chestiness"
due to increased secretions can benefit from appropriate breathing exercises and coughing techniques.

2. **Follow an Exercise Regimen**

- Patients should adhere to an exercise plan outlined by their physiotherapist, which may initially
involve light arm and leg movements to prevent stiffness and promote blood circulation.
3. **Care in ICU or HDU**

- Patients requiring oxygen support during care in ICU or High Dependency Units (HDU) should be
closely monitored. Physiotherapists will assist patients in starting deep breathing exercises and early
mobilization once stable.

4. **Participate in Cardiac Rehabilitation Programs**

- Patients needing cardiac rehabilitation after surgery will typically follow a structured rehabilitation
program designed to improve overall heart and lung function.

### References

1. **"Effectiveness of Preoperative Chest Physiotherapy in Patients Undergoing Elective Cardiac Surgery:

A Systematic Review and Meta-Analysis"** - This article evaluates the role of preoperative respiratory
therapy in preventing PPCs and improving lung function, concluding that preoperative therapy can
reduce the risk of complications.

2. **"Chest Physiotherapy After Coronary Artery Bypass Graft Surgery: A Comparison of Three Different
Deep Breathing Techniques"** - This study compares three deep breathing techniques post-coronary
bypass surgery, showing that assisted breathing techniques can enhance lung function and reduce PPCs.

3. **"Physiotherapy for Heart Surgery"** - This guideline provides information on respiratory exercises
that patients should perform after heart surgery, including deep breathing exercises, early mobilization,
and effective coughing techniques.

4. **"Essentials of Physiotherapy after Thoracic Surgery"** - This article discusses the principles of
physiotherapy following thoracic surgery, including deep breathing techniques, early mobilization, and
reducing chest pressure to prevent PPCs.

In conclusion, chest physiotherapy after cardiac or thoracic surgery is vital for preventing pulmonary
complications, enhancing lung function, and expediting patient recovery. The practices outlined above
should be strictly followed to ensure optimal outcomes for patients recovering from such surgeries.
Cardiac rehabilitation: It is a long term comprehensive rehabilitation programme with graded exercise. It
results in improvement of physical, physiological, and psychological well being of the patient. It is
multidisciplinary programme to improve quality of life. In this the following are explained. Exercise test
protocol: Maximal exercise test: In this treadmill MET, bicycle ergometer MET, bench stepping MET, In
above guidelines, metabolic calculations, valid estimation, ACSm walking equation, Bicycle ergometer
MET, Advantage of ergometer, ACSm leg ergometer equation, Bench stepping MET, ACSm stepping
equation, Submaximal exercise test: In this treadmill sub MET, bicycle ergometer sub MET, Bench
stepping sub MET. In this treadmill has single model stage and multi model stage, bicycle ergometer
SMET, bench stepping SMET, stair climbing SMET, Field test, distance run test, nine or twelve minute run
test, 1 oe 1.5 mile run/walk test, 1 mile jogging test, walking test, step test, additional field test 12
minute swimming test, wait test. Cardiac rehabilitation programme: This has 4 phases: Phase-1:
Inpatient cardiac rehabilitation, Phase-2: Convalescent stage or recovery stage rehabilitation, Stage-3:
Maintenance stage rehabilitation, Stage-4: Commitment stage rehabilitation. Risk factors and guidelines
for management of risk factors. Pulmonary rehabilitation: It is multidisciplinary programme of patient
with acute and chronic respiratory disease designed to increase in over all quality of life of the patient.
PT rehabilitation programme: Respiratory care: 1. Massage manipulations, 2. Breathing exercises, 3.
Postural drainage, 4. Inhalation therapy, 5. Humidification, 6. Techniques for secretion removal like
coughing, huffing, FET and suction, 7. Relaxation, 8. Breathing control, 9. Postural awareness, 10.
Mobilization of upper and lower extremity and Trunk, 11. Home programme.

https://www.scribd.com/document/610480893/Textbook-of-GB-Madhuri-for-Cardio-respiratory-Cardiac-
Surgery-and-Thoracic-Surgery-Conditions