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Safe Lower-extremity Exercise Models That Could Be Implemented In Intensive Care Units Following Coronary Artery Bypass Grafting: Cycle Ergometer and Whole-Body Vibration

Year 2021, Volume: 5 Issue: 2, 371 - 379, 29.05.2021
https://doi.org/10.46237/amusbfd.796401

Abstract

Coronary artery bypass grafting is a surgical method used to treat coronary artery diseases. The frequency of administering this method is increasing every day and this leads to an increase in the number of patients who have undergone this operation, thus more patients experience sudden decreases in postoperative functional and respiratory values in those patients. After the start of the intensive care part of the patients' treatment plan following the coronary artery bypass grafting operation, an immobilization period begins if the patients are not mobilized, and this may lead to an intensive care unit acquired muscle weaknesses, respiratory and functional problems. In order to overcome these complications, it is clear that exercise models that can be safely implemented after the coronary artery bypass grafting operation are needed to promote early mobilization of patients who are sedated and/or mechanically ventilated during their intensive care unit stays. Considering that both the cycle ergometer and the whole body vibration devices have passive exercise modes and that patients must comply with the restrictions imposed on their upper extremities due to sternal precautions following the coronary artery bypass grafting operation, it has become a necessity to investigate the effects of these two exercise models that allow only the lower extremities to work in intensive care unit patients. This review concluded that BE and TVT exercise models may be useful in promoting early mobilization, increasing participation, and preventing various physical and physiological complications associated with immobilization during their stay in the intensive care units following CABG.

References

  • 1. Borges, D. L., Silva, M. G., Silva, L. N., Fortes, J. V., Costa, E. T., Assunção, R. P., et al. (2016). Effects of aerobic exercise applied early after coronary artery bypass grafting on pulmonary function, respiratory muscle strength, and functional capacity: a randomized controlled trial. Journal of Physical Activity, 13(9), 946-951.
  • 2. Patel, M., Dehmer, G., Hirshfeld, J., Smith, P., & Spertus, J. (2012). Appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation J Am Coll Cardiology, 59(857), 81.
  • 3. Radadia, N., & Patel, V. (2019). Post-Coronary Artery Bypass Graft Surgery and Associated Rehabilitation. J Critical Reviews™ in Physical Rehabilitation Medicine, 31(3).
  • 4. Kervan, Ü., Koç, O., Özatik, M. A., Bayraktar, G., Şener, E., Çağlı, K., et al. (2011). Türkiye’deki kalp damar cerrahisi kliniklerinin dağılımı ve hizmetlerinin niteliği. Türk Göğüs Kalp Damar Cerrahisi Dergisi, 19(4), 483-489.
  • 5. Murphy, D. A., & Armour, J. A. (1992). Influences of cardiopulmonary bypass, temperature, cardioplegia, and topical hypothermia on cardiac innervation. J Thorac Cardiovasc Surg, 103(6), 1192-1199.
  • 6. Laitio, T. T., Huikuri, H. V., Koskenvuo, J., Jalonen, J., Mäkikallio, T. H., Helenius, H., et al. (2006). Long-term alterations of heart rate dynamics after coronary artery bypass graft surgery. Anesth Analg, 102(4), 1026-1031.
  • 7. Karadaş, C., & Kapucu, S. Son On Yılda Yoğun Bakım Ünitesi İlişkili Kas Güçsüzlüğüne Yönelik Çalışmaların İncelenmesi: Sistematik Derleme. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 4(3), 1-12.
  • 8. Rawal, G., Yadav, S., & Kumar, R. (2017). Post-intensive care syndrome: an overview. Journal of translational internal medicine, 5(2), 90-92.
  • 9. Hodgson, C. L., Bailey, M., Bellomo, R., Berney, S., Buhr, H., Denehy, L., et al. (2016). A binational multicenter pilot feasibility randomized controlled trial of early goal- directed mobilization in the ICU. J Critical care medicine, 44(6), 1145-1152.
  • 10. Rocha, A. M., Martinez, B., da Silva, V. M., & Junior, L. F. (2017). Early mobilization: Why, what for and how? J Medicina intensiva, 41(7), 429-436.
  • 11. Hodgson, C. L., Berney, S., Harrold, M., Saxena, M., & Bellomo, R. (2013). Clinical review: Early patient mobilization in the ICU. Critical Care, 17(1), 207. doi:10.1186/cc11820
  • 12. Gosselink, R., Bott, J., Johnson, M., Dean, E., Nava, S., Norrenberg, M., et al. (2008). Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on physiotherapy for critically ill patients. Intensive care medicine, 34(7), 1188-1199.
  • 13. Bein, T., Bischoff, M., Brückner, U., Gebhardt, K., Henzler, D., Hermes, C., et al. (2015). S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders. J Der Anaesthesist, 64(1), 1-26.
  • 14. Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., et al. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet, 373(9678), 1874-1882.
  • 15. Klein, K., Mulkey, M., Bena, J. F., & Albert, N. M. (2015). Clinical and psychological effects of early mobilization in patients treated in a neurologic ICU: a comparative study. Crit Care Med, 43(4), 865-873.
  • 16. TEAM-Study-Investigators. (2015). Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. J Critical Care, 19(1), 81-91.
  • 17. Bailey, P., Thomsen, G. E., Spuhler, V. J., Blair, R., Jewkes, J., Bezdjian, L., et al. (2007). Early activity is feasible and safe in respiratory failure patients. Crit Care Med, 35(1), 139-145.
  • 18. Morris, P. E., Goad, A., Thompson, C., Taylor, K., Harry, B., Passmore, L., et al. (2008). Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Journal of Critical Care Medicine, 36(8), 2238-2243.
  • 19. Kho, M. E., Damluji, A., Zanni, J. M., & Needham, D. M. (2012). Feasibility and observed safety of interactive video games for physical rehabilitation in the intensive care unit: a case series. Journal of Critical Care, 27(2), 219. e211-219. e216.
  • 20. Hodgson, C. L., Stiller, K., Needham, D. M., Tipping, C. J., Harrold, M., Baldwin, C. E., et al. (2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. J Critical Care, 18(6), 1-9.
  • 21. Cahalin, L. P., LaPier, T. K., & Shaw, D. K. (2011). Sternal Precautions: Is It Time for Change? Precautions versus Restrictions - A Review of Literature and Recommendations for Revision. Cardiopulm Phys Ther J, 22(1), 5-15.
  • 22. Balachandran, S., Lee, A., Royse, A., Denehy, L., & El-Ansary, D. (2014). Upper limb exercise prescription following cardiac surgery via median sternotomy: a web survey. Journal of cardiopulmonary rehabilitation prevention, 34(6), 390-395.
  • 23. Katijjahbe, M. A., Granger, C. L., Denehy, L., Royse, A., Royse, C., Bates, R., et al. (2018). Standard restrictive sternal precautions and modified sternal precautions had similar effects in people after cardiac surgery via median sternotomy (‘SMART’Trial): a randomised trial. J Journal of physiotherapy, 64(2), 97-106.
  • 24. Kho, M. E., Martin, R. A., Toonstra, A. L., Zanni, J. M., Mantheiy, E. C., Nelliot, A., et al. (2015). Feasibility and safety of in-bed cycling for physical rehabilitation in the intensive care unit. J Crit Care, 30(6), 1419-1425.
  • 25. Preiser, J., De Prato, C., Harvengt, A., Peters, L., Bastin, M., & Fraipont, V. (2014). Passive cycling limits myofibrillar protein catabolism in unconscious patients: a pilot study. J Nov Physiother, 4(4), 1-6.
  • 26. Pires-Neto, R. C., Kawaguchi, Y. M. F., Hirota, A. S., Fu, C., Tanaka, C., Caruso, P., et al. (2013). Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects-a case series. J PLoS One, 8(9), 1-7.
  • 27. Wollersheim, T., Haas, K., Wolf, S., Mai, K., Spies, C., Steinhagen-Thiessen, E., et al. (2017). Whole-body vibration to prevent intensive care unit-acquired weakness: safety, feasibility, and metabolic response. J of Critical Care, 21(1), 1-10.
  • 28. Wang, Y. T., Haines, T. P., Ritchie, P., Walker, C., Ansell, T. A., Ryan, D. T., et al. (2014). Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Critical Care, 18(4), R161.
  • 29. Adler, J., & Malone, D. (2012). Early mobilization in the intensive care unit: a systematic review. Cardiopulmonary physical therapy journal, 23(1), 5.
  • 30. Dubb, R., Nydahl, P., Hermes, C., Schwabbauer, N., Toonstra, A., Parker, A. M., et al. (2016). Barriers and strategies for early mobilization of patients in intensive care units. Annals of the American Thoracic Society, 13(5), 724-730.
  • 31. Olkowski, B. F., & Shah, S. O. (2017). Early Mobilization in the Neuro-ICU: How Far Can We Go? Neurocrit Care, 27(1), 141-150.
  • 32. King, J., & Crowe, J. (1998). Mobilization practices in Canadian critical care units. Journal of Physiotherapy Canada, 50(3), 206-211.
  • 33. Morris, P. E. (2007). Moving our critically ill patients: mobility barriers and benefits. Crit Care Clin, 23(1), 1-20.
  • 34. Fan, E., Cheek, F., Chlan, L., Gosselink, R., Hart, N., Herridge, M. S., et al. (2014). An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit–acquired weakness in adults. Am J Respir Crit Care Med, 190(12), 1437-1446.
  • 35. Burtin, C., Clerckx, B., Robbeets, C., Ferdinande, P., Langer, D., Troosters, T., et al. (2009). Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med, 37(9), 2499-2505.
  • 36. Sañudo, B., Seixas, A., Gloeckl, R., Rittweger, J., Rawer, R., Taiar, R., et al. (2020). Potential Application of Whole Body Vibration Exercise for Improving the Clinical Conditions of COVID-19 Infected Individuals: A Narrative Review from the World Association of Vibration Exercise Experts (WAVex) Panel. International Journal of Environmental Research Public Health, 17(10), 3650-3673.
  • 37. Wang, H.-H., Chen, W.-H., Liu, C., Yang, W.-W., Huang, M.-Y., & Shiang, T.-Y. (2014). Whole-body vibration combined with extra-load training for enhancing the strength and speed of track and field athletes. The Journal of Strength Conditioning Research, 28(9), 2470-2477.
  • 38. Cochrane, D., & Stannard, S. (2005). Acute whole body vibration training increases vertical jump and flexibility performance in elite female field hockey players. Br J Sports Med, 39(11), 860-865.
  • 39. Monteleone, G., De Lorenzo, A., Sgroi, M., De Angelis, S., & Di Renzo, L. (2007). Contraindications for whole body vibration training. J Sports Med Phys Fitness, 47(4), 443- 445.
  • 40. Vargas, F. S., Cukier, A., Terra-Filho, M., Hueb, W., Teixeira, L. R., & Light, R. W. (1992). Relationship between pleural changes after myocardial revascularization and pulmonary mechanics. Chest, 102(5), 1333-1336.

Koroner Arter Bypass Greftleme Sonrası Yoğun Bakımda Uygulanabilecek Güvenli Alt Ekstremite Egzersiz Modelleri: Bisiklet Ergometresi ve Tüm Vücut Titreşimi

Year 2021, Volume: 5 Issue: 2, 371 - 379, 29.05.2021
https://doi.org/10.46237/amusbfd.796401

Abstract

Koroner arter bypass greftleme, koroner arter rahatsızlıklarında sıklıkla kullanılan cerrahi bir yöntemdir. Bu yöntemin uygulanma sıklığı da gün geçtikçe artmakta ve bu da bu operasyonu geçirmiş hasta sayısının artmasına ve böylece bu hastalarda, operasyon sonrası fonksiyonel ve solunumsal değerlerde ani düşüşlere yol açmaktadır. Koroner arter bypass greftleme operasyonu sonrasında hastaların yoğun bakım süreçlerinin başlamasıyla birlikte, eğer hastalar mobilize edilmezlerse, bir immobilizasyon süreci başlar ve bu da hastalarda yoğun bakım kaynaklı kas zayıflıklarına, solunumsal ve fonksiyonel problemlere yol açabilir. Bu komplikasyonların üstesinden gelebilmek için, özellikle uyutulan ve/veya mekanik ventilatöre bağlı olan hastaların, yoğun bakımdayken erken mobilizasyona katılımlarını sağlamak için Koroner arter bypass greftleme opareasyonu sonrası güvenle uygulanabilecek egzersiz modellerine ihtiyaç vardır. Hem bisiklet ergometresinin, hem de tüm vücut titreşim cihazlarının pasif egzersiz modlarının olduğu ve Koroner arter bypass greftleme operasyonundan sonra sternal önlemlerden dolayı hastaların üst ekstremitelerine getirilen kısıtlamalara uymaları gerektiği düşünüldüğünde, sadece alt ekstremiteleri çalıştırma olanağı veren bu iki egzersiz modellinin yoğun bakım hastalarına olan etkilerini araştırılması gereklilik haline gelmiştir. Bu derleme, BE ve TVT egzersiz modellerinin, KABG sonrasındaki yoğun bakım sürecinde erken mobilizasyona destek olma, katılımı artırma, immobilizasyona bağlı olarak gelişen çeşitli fiziksel ve fizyolojik komplikasyonların önüne geçmede faydalı olabileceği sonucuna varmaktadır.

References

  • 1. Borges, D. L., Silva, M. G., Silva, L. N., Fortes, J. V., Costa, E. T., Assunção, R. P., et al. (2016). Effects of aerobic exercise applied early after coronary artery bypass grafting on pulmonary function, respiratory muscle strength, and functional capacity: a randomized controlled trial. Journal of Physical Activity, 13(9), 946-951.
  • 2. Patel, M., Dehmer, G., Hirshfeld, J., Smith, P., & Spertus, J. (2012). Appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation J Am Coll Cardiology, 59(857), 81.
  • 3. Radadia, N., & Patel, V. (2019). Post-Coronary Artery Bypass Graft Surgery and Associated Rehabilitation. J Critical Reviews™ in Physical Rehabilitation Medicine, 31(3).
  • 4. Kervan, Ü., Koç, O., Özatik, M. A., Bayraktar, G., Şener, E., Çağlı, K., et al. (2011). Türkiye’deki kalp damar cerrahisi kliniklerinin dağılımı ve hizmetlerinin niteliği. Türk Göğüs Kalp Damar Cerrahisi Dergisi, 19(4), 483-489.
  • 5. Murphy, D. A., & Armour, J. A. (1992). Influences of cardiopulmonary bypass, temperature, cardioplegia, and topical hypothermia on cardiac innervation. J Thorac Cardiovasc Surg, 103(6), 1192-1199.
  • 6. Laitio, T. T., Huikuri, H. V., Koskenvuo, J., Jalonen, J., Mäkikallio, T. H., Helenius, H., et al. (2006). Long-term alterations of heart rate dynamics after coronary artery bypass graft surgery. Anesth Analg, 102(4), 1026-1031.
  • 7. Karadaş, C., & Kapucu, S. Son On Yılda Yoğun Bakım Ünitesi İlişkili Kas Güçsüzlüğüne Yönelik Çalışmaların İncelenmesi: Sistematik Derleme. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 4(3), 1-12.
  • 8. Rawal, G., Yadav, S., & Kumar, R. (2017). Post-intensive care syndrome: an overview. Journal of translational internal medicine, 5(2), 90-92.
  • 9. Hodgson, C. L., Bailey, M., Bellomo, R., Berney, S., Buhr, H., Denehy, L., et al. (2016). A binational multicenter pilot feasibility randomized controlled trial of early goal- directed mobilization in the ICU. J Critical care medicine, 44(6), 1145-1152.
  • 10. Rocha, A. M., Martinez, B., da Silva, V. M., & Junior, L. F. (2017). Early mobilization: Why, what for and how? J Medicina intensiva, 41(7), 429-436.
  • 11. Hodgson, C. L., Berney, S., Harrold, M., Saxena, M., & Bellomo, R. (2013). Clinical review: Early patient mobilization in the ICU. Critical Care, 17(1), 207. doi:10.1186/cc11820
  • 12. Gosselink, R., Bott, J., Johnson, M., Dean, E., Nava, S., Norrenberg, M., et al. (2008). Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on physiotherapy for critically ill patients. Intensive care medicine, 34(7), 1188-1199.
  • 13. Bein, T., Bischoff, M., Brückner, U., Gebhardt, K., Henzler, D., Hermes, C., et al. (2015). S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders. J Der Anaesthesist, 64(1), 1-26.
  • 14. Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., et al. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet, 373(9678), 1874-1882.
  • 15. Klein, K., Mulkey, M., Bena, J. F., & Albert, N. M. (2015). Clinical and psychological effects of early mobilization in patients treated in a neurologic ICU: a comparative study. Crit Care Med, 43(4), 865-873.
  • 16. TEAM-Study-Investigators. (2015). Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. J Critical Care, 19(1), 81-91.
  • 17. Bailey, P., Thomsen, G. E., Spuhler, V. J., Blair, R., Jewkes, J., Bezdjian, L., et al. (2007). Early activity is feasible and safe in respiratory failure patients. Crit Care Med, 35(1), 139-145.
  • 18. Morris, P. E., Goad, A., Thompson, C., Taylor, K., Harry, B., Passmore, L., et al. (2008). Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Journal of Critical Care Medicine, 36(8), 2238-2243.
  • 19. Kho, M. E., Damluji, A., Zanni, J. M., & Needham, D. M. (2012). Feasibility and observed safety of interactive video games for physical rehabilitation in the intensive care unit: a case series. Journal of Critical Care, 27(2), 219. e211-219. e216.
  • 20. Hodgson, C. L., Stiller, K., Needham, D. M., Tipping, C. J., Harrold, M., Baldwin, C. E., et al. (2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. J Critical Care, 18(6), 1-9.
  • 21. Cahalin, L. P., LaPier, T. K., & Shaw, D. K. (2011). Sternal Precautions: Is It Time for Change? Precautions versus Restrictions - A Review of Literature and Recommendations for Revision. Cardiopulm Phys Ther J, 22(1), 5-15.
  • 22. Balachandran, S., Lee, A., Royse, A., Denehy, L., & El-Ansary, D. (2014). Upper limb exercise prescription following cardiac surgery via median sternotomy: a web survey. Journal of cardiopulmonary rehabilitation prevention, 34(6), 390-395.
  • 23. Katijjahbe, M. A., Granger, C. L., Denehy, L., Royse, A., Royse, C., Bates, R., et al. (2018). Standard restrictive sternal precautions and modified sternal precautions had similar effects in people after cardiac surgery via median sternotomy (‘SMART’Trial): a randomised trial. J Journal of physiotherapy, 64(2), 97-106.
  • 24. Kho, M. E., Martin, R. A., Toonstra, A. L., Zanni, J. M., Mantheiy, E. C., Nelliot, A., et al. (2015). Feasibility and safety of in-bed cycling for physical rehabilitation in the intensive care unit. J Crit Care, 30(6), 1419-1425.
  • 25. Preiser, J., De Prato, C., Harvengt, A., Peters, L., Bastin, M., & Fraipont, V. (2014). Passive cycling limits myofibrillar protein catabolism in unconscious patients: a pilot study. J Nov Physiother, 4(4), 1-6.
  • 26. Pires-Neto, R. C., Kawaguchi, Y. M. F., Hirota, A. S., Fu, C., Tanaka, C., Caruso, P., et al. (2013). Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects-a case series. J PLoS One, 8(9), 1-7.
  • 27. Wollersheim, T., Haas, K., Wolf, S., Mai, K., Spies, C., Steinhagen-Thiessen, E., et al. (2017). Whole-body vibration to prevent intensive care unit-acquired weakness: safety, feasibility, and metabolic response. J of Critical Care, 21(1), 1-10.
  • 28. Wang, Y. T., Haines, T. P., Ritchie, P., Walker, C., Ansell, T. A., Ryan, D. T., et al. (2014). Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Critical Care, 18(4), R161.
  • 29. Adler, J., & Malone, D. (2012). Early mobilization in the intensive care unit: a systematic review. Cardiopulmonary physical therapy journal, 23(1), 5.
  • 30. Dubb, R., Nydahl, P., Hermes, C., Schwabbauer, N., Toonstra, A., Parker, A. M., et al. (2016). Barriers and strategies for early mobilization of patients in intensive care units. Annals of the American Thoracic Society, 13(5), 724-730.
  • 31. Olkowski, B. F., & Shah, S. O. (2017). Early Mobilization in the Neuro-ICU: How Far Can We Go? Neurocrit Care, 27(1), 141-150.
  • 32. King, J., & Crowe, J. (1998). Mobilization practices in Canadian critical care units. Journal of Physiotherapy Canada, 50(3), 206-211.
  • 33. Morris, P. E. (2007). Moving our critically ill patients: mobility barriers and benefits. Crit Care Clin, 23(1), 1-20.
  • 34. Fan, E., Cheek, F., Chlan, L., Gosselink, R., Hart, N., Herridge, M. S., et al. (2014). An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit–acquired weakness in adults. Am J Respir Crit Care Med, 190(12), 1437-1446.
  • 35. Burtin, C., Clerckx, B., Robbeets, C., Ferdinande, P., Langer, D., Troosters, T., et al. (2009). Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med, 37(9), 2499-2505.
  • 36. Sañudo, B., Seixas, A., Gloeckl, R., Rittweger, J., Rawer, R., Taiar, R., et al. (2020). Potential Application of Whole Body Vibration Exercise for Improving the Clinical Conditions of COVID-19 Infected Individuals: A Narrative Review from the World Association of Vibration Exercise Experts (WAVex) Panel. International Journal of Environmental Research Public Health, 17(10), 3650-3673.
  • 37. Wang, H.-H., Chen, W.-H., Liu, C., Yang, W.-W., Huang, M.-Y., & Shiang, T.-Y. (2014). Whole-body vibration combined with extra-load training for enhancing the strength and speed of track and field athletes. The Journal of Strength Conditioning Research, 28(9), 2470-2477.
  • 38. Cochrane, D., & Stannard, S. (2005). Acute whole body vibration training increases vertical jump and flexibility performance in elite female field hockey players. Br J Sports Med, 39(11), 860-865.
  • 39. Monteleone, G., De Lorenzo, A., Sgroi, M., De Angelis, S., & Di Renzo, L. (2007). Contraindications for whole body vibration training. J Sports Med Phys Fitness, 47(4), 443- 445.
  • 40. Vargas, F. S., Cukier, A., Terra-Filho, M., Hueb, W., Teixeira, L. R., & Light, R. W. (1992). Relationship between pleural changes after myocardial revascularization and pulmonary mechanics. Chest, 102(5), 1333-1336.
There are 40 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Review Articles
Authors

Dinçer Cüre 0000-0001-6746-5070

Publication Date May 29, 2021
Published in Issue Year 2021 Volume: 5 Issue: 2

Cite

APA Cüre, D. (2021). Koroner Arter Bypass Greftleme Sonrası Yoğun Bakımda Uygulanabilecek Güvenli Alt Ekstremite Egzersiz Modelleri: Bisiklet Ergometresi ve Tüm Vücut Titreşimi. Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 5(2), 371-379. https://doi.org/10.46237/amusbfd.796401