Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery

https://doi.org/10.4081/monaldi.2009.324

Authors

  • Laura Crespi U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.
  • Monica Bosco | monica.bosco@multimedica.it U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.
  • Naika Scalabrino U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.
  • Massimo Baravelli U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.
  • Anna Picozzi U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.
  • Andrea Rossi U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.
  • Melania Romano U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.
  • Daniela Imperiale U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.
  • Silvana Borghi U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.
  • Elisabetta Brunello U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.
  • Claudio Anzà U.O. Riabilitazione Cardiologica Intensiva, IRCCS Multimedica Holding, Castellanza (Va), Italy.

Abstract

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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Published
2016-01-19
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Section
Original Articles
Keywords:
physiotherapy, respiratory care, cardiac surgery, tracheostomy, decannulation
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How to Cite
Crespi, Laura, Monica Bosco, Naika Scalabrino, Massimo Baravelli, Anna Picozzi, Andrea Rossi, Melania Romano, Daniela Imperiale, Silvana Borghi, Elisabetta Brunello, and Claudio Anzà. 2016. “Intensive Physiotherapic Respiratory Care in Critically Ill Patients With Tracheostomy After Cardiac Surgery”. Monaldi Archives for Chest Disease 72 (3). https://doi.org/10.4081/monaldi.2009.324.

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