Physiotherapy Management of thoracic surgery

• Potential Problems:

  • Patient assessment and education may have been undertaking pre-op
  • Post-op need systematic assessment
  • Problems:
  • Pain
  • Reduced lung volumes / Atelectasis
  • Excess bronchial secretions
  • Reduced thoracic mobility
  • Reduced exercise tolerance
• Treatment Considerations:

  • Adequate analgesia
  • Suction
  • Clamp / transportation of ICD
  • Lines
• Physiotherapy:

  • Early mobility / Positioning
  • CPAP - continuous positive airways pressure
  • ACBT - active cycle of breathing techniques
  • Inspiratory hold / sniff - emphasis of deep breaths and holding it to recruit collateral channels of ventilation
  • Modify gravity assisted positioning if theres secretions
  • Supported cough
  • IPPB (low pressures) - intermittent positive pressure breathing
  • Postural correction
  • Shoulder girdle mobility
• Treatment Progression:

  • Pedals
  • Exercise bike
  • Stairs
  • Pulmonary rehabilitation
• Precautions:

  • Risk of rapid post op deterioration
  • Care with positive pressure techniques:
  • manual hyperinflation
  • IPPB - intermittent positive pressure breathing
  • Post pneumonectomy
  • Care with positioning
  • Extreme caution if suctioning patient