Chest physical therapy in surgery: a theoretical model about who to treat

Olsén, M. Fagevik

doi:10.1183/18106838.0104.308

Cited by 12 publications

(7 citation statements)

References 29 publications

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“…Our research group has performed several trials within this field in the last 15 years. The summarized results have been presented previously (2). None of the patients groups included in that article had as low VC levels as in the patients undergoing cholecystectomies in the study by Ali et al (9).…”

Section: Discussionmentioning

confidence: 91%

“…During the last few decades, anaesthesia, analgesia and surgical procedures have developed tremendously with the introduction of laparoscopic as well as thoracoscopic surgery and the increasing use of epidural anaesthesia. Despite the development, there is still a risk of postoperative pulmonary complications (PPCs), such as atelectasis and pneumonia, especially after surgery in the upper abdomen or thorax (2,7,8). Early ambulation and different breathing exercises are used to avoid these complications.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of abdominal binder after major upper gastrointestinal surgery

Olsén

Josefson

Wiklund

2009

Advances in Physiotherapy

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The aim of the study was to evaluate the use of an elastic abdominal binder after open major upper abdominal surgery. In the trial, 50 patients undergoing major upper abdominal surgery were included, of which 37 were evaluated also postoperatively. The patients were randomized either to use an elastic binder during the first 5 postoperative days or to a standard treatment group. Preoperatively and postoperative days 1, 3 and 5, oxygen saturation and spirometry were investigated. The tests were performed in sitting and supine position. The patients using the binder were additionally tested without the binder. Postoperatively, treatment with oxygen and bronchodilators, signs of pulmonary complications, rate of mobilization, pain when changing position from supine to sitting and length of hospital stay were recorded. The patients who used the binder estimated the degree of comfort of the binder. Lung function deteriorated considerably postoperatively in both groups. There were no significant differences between the groups in any of the variables. The patients using the binder found it comfortable but reported liking it less at the end of the follow-up period. There is no objective clinical effect of a routine use of an elastic binder after major upper abdominal surgery. However, the majority of the patients using it found it comfortable especially during the first postoperative days.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Evaluation of abdominal binder after major upper gastrointestinal surgery

Olsén

Josefson

Wiklund

2009

Advances in Physiotherapy

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“…Functional residual capacity (FRC) and lung compliance are reduced, and airway resistance increased [ 18 ], predisposing the patient to airway closure, increased work of breathing, and decreased arterial oxygen pressure. These effects are accentuated with anesthesia and abdominal surgery [ 22 ] contributing to greater risk of complications, especially in patients undergoing open abdominal and thoracic procedures or high-risk patients, e.g., overweight individuals, smokers, and those with pulmonary diseases [ 23 ]. In addition, physical deconditioning associated with immobility during bed rest, begins rapidly [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Short-term effects of mobilization on oxygenation in patients after open surgery for pancreatic cancer: a randomized controlled trial

2021

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Background Despite the unequivocal role of progressive mobilization in post-surgical patient management, its specific effects and timing, particularly after abdominal surgery, remain debated. This study’s aim was to examine the short-term effects of mobilization on oxygenation in hemodynamically stable patients after open surgery for pancreatic cancer. Methods A randomized controlled clinical trial was conducted in which patients (n = 83) after open pancreatic surgery were randomized to either the same-day mobilization group (mobilized when hemodynamically stable within four hours after surgery) or the next-day mobilization group (mobilized first time in the morning of the first post-operative day). Mobilization was prescribed and modified based on hemodynamic and subjective responses with the goal of achieving maximal benefit with minimal risk. Blood gas samples were taken three times the evening after surgery; and before and after mobilization on the first post-operative day. Spirometry was conducted pre-operatively and on the first post-operative day. Adverse events and length of stay in postoperative intensive care were also recorded. Results With three dropouts, 80 patients participated (40 per group). All patients in the same-day mobilization group, minimally sat over the edge of the bed on the day of surgery and all patients (both groups) minimally sat over the edge of the bed the day after surgery. Compared with patients in the next-day mobilization group, patients in the same-day mobilization group required lower FiO2 and had higher SaO2/FiO2 at 1800 h on the day of surgery (p < .05). On the day after surgery, FiO2, SaO2/FiO2, PaO2/FiO2, and alveolar-arterial oxygen gradient, before and after mobilization, were superior in the same-day mobilization group (p < 0.05). No differences were observed between groups in PCO2, pH, spirometry or length stay in postoperative intensive care. Conclusions Compared with patients after open pancreatic surgery in the next-day mobilization group, those in the same-day mobilization group, once hemodynamically stable, improved oxygenation to a greater extent after mobilization. Our findings support prescribed progressive mobilization in patients after pancreatic surgery (when hemodynamically stable and titrated to their individual responses and safety considerations), on the same day of surgery to augment oxygenation, potentially helping to reduce complications and hasten functional recovery. Trial registration: This prospective RCT was carried out at the Sahlgrenska University Hospital, Sweden. The study was approved by the Regional Ethical Review Board in Gothenburg (Registration number: 437-17). Trial registration: “FoU in Sweden” (Research and Development in Sweden, URL: https://www.researchweb.org/is/vgr) id: 238701 Registered 13 December 2017 and Clinical Trials (URL:clinicaltrials.gov) NCT03466593. Registered 15 March 2018.

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“…, 2009; WHO 2010). In addition, many neurological diseases/trauma cause deterioration of the respiration and almost all patients undergoing anaesthesia and surgery have restrictive lung function postoperatively (Fagevik Olsén, 2005; Stolzmann et al. , 2008).…”

Section: Introductionmentioning

confidence: 99%

“…One primary group of patients has restrictive or obstructive lung diseases but patients with other diagnoses may also have impaired respiration as musculoskeletal changes in the thorax and spine because of scoliosis or rheumatological diseases (Pehrsson et al, 1991;Kearon et al, 1993;Takahashi et al, 2007;Avnon et al, 2009;WHO 2010). In addition, many neurological diseases ⁄ trauma cause deterioration of the respiration and almost all patients undergoing anaesthesia and surgery have restrictive lung function postoperatively (Fagevik Olsén, 2005;Stolzmann et al, 2008).…”

Section: Introductionmentioning

confidence: 99%