Göğüs Cerrahisi Sonrası Erken Dönemde Uygulanan Fizyoterapinin Hemodinamik Etkileri

Yıl 2019, , 87 - 92, 13.06.2019

Esra Pehlivan , Arif Balcı Feride Elçin Cagay Z. Nilgün Ulukol

https://doi.org/10.21673/anadoluklin.495671

Öz

Amaç: Çalışmamızın amacı torokotomi sonrası yoğun bakım
ünitesinde yatmakta olan hastalarda erken dönemde uygulanan fizyoterapinin
hemodinamik etkilerinin belirlenmesidir.

Gereç ve Yöntemler: Torokotomi yapılan ve cerrahi yoğun
bakımda 24 saatlerini tamamlayan hastalar çalışmaya dahil edildi. Hastalara
solunum egzersizleri, insentif spirometre çalışması, destekli öksürme ve
mobilizasyon içerikli fizyoterapi programı, cerrahi yoğun bakım ünitesinde
uygulandı. Hastaların tedavi öncesinde, sonrasında ve 5 dakika
toparlanmalarının ardından sistolik (SKB) ve diastolik kan basınçları (DKB),
kalp hızı (KH) ve oksijen saturasyonları (SpO₂) kaydedildi. Ağrı seviyeleri ise vizüel analog
skalası (VAS, 0-10) kullanılarak değerlendirildi.

Bulgular: Yirmiikisi (%30) kadın, 50 (%70)’si erkek, yaş ortalaması
59 olan 72 hasta çalışmaya alındı. 
Tedavi öncesi ve sonrası karşılaştırılmasında DKB’de yükselme (p=,006),
tedavi sonrası ve 5 dakika toparlanma karşılaştırılmasında KH’de düşme
(p=,008), tedavi öncesi ve 5 dakika toparlanma karşılaştırmasında ise KH’deki
düşme (p=,026) ve DKB’deki yükselme (p=,014) istatistiksel olarak anlamlıydı.
Meydana gelen hemodinamik değişimler fizyolojik limitler içindeydi.

Sonuç: Çalışmamızdan
elde edilen sonuçlara göre cerrahi yoğun bakım ünitesinde uygulanan erken dönem
fizyoterapi güvenlidir. Fizyolojik yanıtları gözlemlemek ve hasta güvenliğini
sağlamak amacıyla fizyoterapi sırasında hemodinamik parametreler sürekli
monitorize edilmelidir.

Anahtar Kelimeler

göğüs fizyoterapisi, torokotomi, hemodinamik cevap, yoğun bakım ünitesi

Hemodynamic Effects of Early Physiotherapy in Intensive Care Unit after Chest Surgery

Öz

Aim: To determine the haemodynamic effects of early physiotherapy
programme in intensive care unit after thoracotomy.

Materials and Methods: The patients who
underwent torocotomy and completed 24 hours in surgical intensive care unit were
included in the study. The physiotherapy program consisted of breathing
exercises, incentive spirometer tarining, assisted coughing and mobilization
were applied in surgical intensive care unit. The systolic (SBP) and diastolic
blood pressure (DBP), heart rate (HR) and oxygen saturation (SpO₂)
were recorded before, during and after the treatment for 5 minutes. Pain level was assessed with
Visual Analogue Scale (VAS, 0–10).

Results: Seventy-two patients who
were 22 (30%) of female, 50 (70%) of male and 
mean age was 72 (mean age 59) were included in the study. The increase
in DBP (p = .006) in the comparison of before and after treatment, the decrease
in HR in the comparasion of after treatment and 5-minutes recovery  (p = .008), the decrease in HR (p = .026) and
increase in DBP (p = .014) in the comparasion of pre-treatment and 5-minute
recovery were statistically significant. The hemodynamic changes were within
the physiological limits.

Discussion and Conclusion: According to the results
of our study, early physiotherapy applied in surgical intensive care unit is
safe. Hemodynamic parameters should be monitored continuously during
physiotherapy to monitor physiological responses and ensure patient safety.

Anahtar Kelimeler

chest physiotherapy, thoracotomy, haemodynamic responses, intensive care

Kaynakça

• 1. Haller G, Walder B. Postoperative pulmonary complications - Still room for improvement. Eur J Anaesthesiol. 2017;34(8):489-91.
• 2. Bendixen M, Jorgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol. 2016;17(6):836-44.
• 3. Baddeley RA. Physiotherapy for enhanced recovery in thoracic surgery. Journal of thoracic disease. 2016;8(Suppl 1):S107-10.
• 4. Naccarato M, Leviner S, Proehl J, Barnason S, Brim C, Crowley M, et al. Emergency Nursing Resource: orthostatic vital signs. Emergency Nurs. 2012;38(5):447-53.
• 5. Agostini P, Naidu B, Cieslik H, Steyn R, Rajesh PB, Bishay E, et al. Effectiveness of incentive spirometry in patients following thoracotomy and lung resection including those at high risk for developing pulmonary complications. Thorax. 2013;68(6):580-5.
• 6. Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest. 2001;120(3):971-8.
• 7. Rupp M, Miley H, Russell-Babin K. Incentive spirometry in postoperative abdominal/thoracic surgery patients. AACN Adv Criti Care. 2013;24(3):255-63.
• 8. Melendez JA, Alagesan R, Reinsel R, Weissman C, Burt M. Postthoracotomy respiratory muscle mechanics during incentive spirometry using respiratory inductance plethysmography. Chest. 1992;101(2):432-6.
• 9. Schmidt I. [Assisted cough--physiotherapy to improve expectoration of mucus]. Pneumologie. 2008;62 Suppl 1:S23-7.
• 10. Sobush DC. Is the application of external thoracic support following median sternotomy a placebo or a prudent intervention strategy? Respir care. 2008;53(8):1010-1.
• 11. Hodgson CL, Berney S, Harrold M, Saxena M, Bellomo R. Clinical review: early patient mobilization in the ICU. Criti care. 2013;17(1):207.
• 12. Schujmann DS, Lunardi AC, Fu C. Progressive mobility program and technology to increase the level of physical activity and its benefits in respiratory, muscular system, and functionality of ICU patients: study protocol for a randomized controlled trial. Trials. 2018;19(1):274.
• 13. Khan MH, Kunselman AR, Leuenberger UA, Davidson WR, Jr., Ray CA, Gray KS, et al. Attenuated sympathetic nerve responses after 24 hours of bed rest. Am J Physiol Heart Circ Physiol. 2002;282(6):H2210-5.
• 14. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.
• 15. Castelino T, Fiore JF, Jr., Niculiseanu P, Landry T, Augustin B, Feldman LS. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review. Surgery. 2016;159(4):991-1003.
• 16. Hanada M, Kanetaka K, Hidaka S, Taniguchi K, Oikawa M, Sato S, et al. Effect of early mobilization on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic surgery on the esophagus. Esophagus. 2018;15(2):69-74.
• 17. Arbane G, Douiri A, Hart N, Hopkinson NS, Singh S, Speed C, et al. Effect of postoperative physical training on activity after curative surgery for non-small cell lung cancer: a multicentre randomised controlled trial. Physiotherapy. 2014;100(2):100-7.
• 18. Kaneda H, Saito Y, Okamoto M, Maniwa T, Minami K, Imamura H. Early postoperative mobilization with walking at 4 hours after lobectomy in lung cancer patients. Gen Thorac Cardiovasc Surg. 2007;55(12):493-8.
• 19. Klein P, Kemper M, Weissman C, Rosenbaum SH, Askanazi J, Hyman AI. Attenuation of the hemodynamic responses to chest physical therapy. Chest. 1988;93(1):38-42.
• 20. Selwyn AP BE. Harrison’s Principles of Internal Medicine. Harrison’s Principles of Internal Medicine (Baltimore), 15th ed. 2001:1399-410.
• 21. Wong. W. Use of body positioning in the mechanically ventilated patient with acute respiratory failure: application of Sackett's rules of evidence. Physioter Theory Pract. 2009;15(1):25-41.
• 22. Stiller K, Phillips, AC., P. Lambert. The safety of mobilisation and its effect on haemodynamic and respiratory status of intensive care patients. Physioter Theory Pract. 2004;20:175-85.