Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery
Background. Patients following major cardiac surgery are increasingly elderly and present many comorbidities. For these reasons their post-operative phase is often burdened by several complications requiring a long stay in Critical Care and prolonged mechanical ventilation. Most of these patients, w...
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2016-01-01
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| Series: | Monaldi Archives for Chest Disease |
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| Online Access: | https://www.monaldi-archives.org/index.php/macd/article/view/324 |
| _version_ | 1818284953464471552 |
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| author | Laura Crespi Monica Bosco Naika Scalabrino Massimo Baravelli Anna Picozzi Andrea Rossi Melania Romano Daniela Imperiale Silvana Borghi Elisabetta Brunello Claudio Anzà |
| author_facet | Laura Crespi Monica Bosco Naika Scalabrino Massimo Baravelli Anna Picozzi Andrea Rossi Melania Romano Daniela Imperiale Silvana Borghi Elisabetta Brunello Claudio Anzà |
| author_sort | Laura Crespi |
| collection | DOAJ |
| description | Background. Patients following major cardiac surgery are increasingly elderly and present many comorbidities. For these reasons their post-operative phase is often burdened by several complications requiring a long stay in Critical Care and prolonged mechanical ventilation. Most of these patients, when transferred to our Intensive Cardiac Rehabilitation Unit, still have a percutaneous tracheostomy due to respiratory mechanical dysfunction. The aim of our work is to present new rehabilitative care strategies in such compromised patients. Methods and materials. We studied 27 elderly critically ill tracheostomized patients who were split into 2 Groups (A = 11 and B = 16). The Groups were homogeneous for age and for left ventricular ejection fraction. Group A received a standard treatment including cautious mobilisation and respiratory unspecific physiotherapy. Group B received an earlier and more aggressive treatment with a specific respiratory physiotherapy including Positive Expiration Pressure (PEP) directly connected to the tracheostomy cannula. A protocol for tracheostomy decannulation by assessment of the Peak Expiratory Flow during cough (PCEF≥ 180 L/min.) has been defined in order to verify the patients ability to develop a mechanically effective cough to obtain weaning from tracheostomy. Besides, in the patients of Group B, we carried out a screening of the swallowing dysfunction. Results. Four patients of Group A deceased while in Group B there were no deaths. Furthermore patients of Group B showed a statistically significant improvement of mobility and respiratory indexes. In Group B only one patient was discharged with tracheostomy cannula in site because he did not reach standard criteria for decannulation and his PCEF value was not satisfactory. This patient underwent percutaneous gastrostomy. Conclusions. A precocious and intensive rehabilitation, based on specific respiratory physiotherapy, significantly improves mobility and respiratory indexes of patients with tracheostomy. The PCEF and the swallowing deficit evaluation allows an earlier tracheostomy decannulation with lower risk of complications. |
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| issn | 1122-0643 2532-5264 |
| language | English |
| last_indexed | 2024-12-13T01:01:00Z |
| publishDate | 2016-01-01 |
| publisher | PAGEPress Publications |
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| series | Monaldi Archives for Chest Disease |
| spelling | doaj.art-e9b828414b494d97a94c88024d7ccf142022-12-22T00:04:41ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642016-01-0172310.4081/monaldi.2009.324Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgeryLaura Crespi0Monica Bosco1Naika Scalabrino2Massimo Baravelli3Anna Picozzi4Andrea Rossi5Melania Romano6Daniela Imperiale7Silvana Borghi8Elisabetta Brunello9Claudio Anzà10U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va)Background. Patients following major cardiac surgery are increasingly elderly and present many comorbidities. For these reasons their post-operative phase is often burdened by several complications requiring a long stay in Critical Care and prolonged mechanical ventilation. Most of these patients, when transferred to our Intensive Cardiac Rehabilitation Unit, still have a percutaneous tracheostomy due to respiratory mechanical dysfunction. The aim of our work is to present new rehabilitative care strategies in such compromised patients. Methods and materials. We studied 27 elderly critically ill tracheostomized patients who were split into 2 Groups (A = 11 and B = 16). The Groups were homogeneous for age and for left ventricular ejection fraction. Group A received a standard treatment including cautious mobilisation and respiratory unspecific physiotherapy. Group B received an earlier and more aggressive treatment with a specific respiratory physiotherapy including Positive Expiration Pressure (PEP) directly connected to the tracheostomy cannula. A protocol for tracheostomy decannulation by assessment of the Peak Expiratory Flow during cough (PCEF≥ 180 L/min.) has been defined in order to verify the patients ability to develop a mechanically effective cough to obtain weaning from tracheostomy. Besides, in the patients of Group B, we carried out a screening of the swallowing dysfunction. Results. Four patients of Group A deceased while in Group B there were no deaths. Furthermore patients of Group B showed a statistically significant improvement of mobility and respiratory indexes. In Group B only one patient was discharged with tracheostomy cannula in site because he did not reach standard criteria for decannulation and his PCEF value was not satisfactory. This patient underwent percutaneous gastrostomy. Conclusions. A precocious and intensive rehabilitation, based on specific respiratory physiotherapy, significantly improves mobility and respiratory indexes of patients with tracheostomy. The PCEF and the swallowing deficit evaluation allows an earlier tracheostomy decannulation with lower risk of complications.https://www.monaldi-archives.org/index.php/macd/article/view/324physiotherapyrespiratory carecardiac surgerytracheostomydecannulation |
| spellingShingle | Laura Crespi Monica Bosco Naika Scalabrino Massimo Baravelli Anna Picozzi Andrea Rossi Melania Romano Daniela Imperiale Silvana Borghi Elisabetta Brunello Claudio Anzà Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery Monaldi Archives for Chest Disease physiotherapy respiratory care cardiac surgery tracheostomy decannulation |
| title | Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery |
| title_full | Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery |
| title_fullStr | Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery |
| title_full_unstemmed | Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery |
| title_short | Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery |
| title_sort | intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery |
| topic | physiotherapy respiratory care cardiac surgery tracheostomy decannulation |
| url | https://www.monaldi-archives.org/index.php/macd/article/view/324 |
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