Efficacy of Early and Enhanced Respiratory Physiotherapy and Mobilization after On-Pump Cardiac Surgery: A Prospective Randomized Controlled Trial

Background: This randomized controlled trial aimed to investigate the influence of physical activity and respiratory physiotherapy on zero postoperative day on clinical, hemodynamic and respiratory parameters of patients undergoing cardiac surgeries under extracorporeal circulation. Methods: 78 patients undergoing coronary artery bypass graft (CABG) or/and valvular heart disease surgeries were randomly assigned into an early and enhanced physiotherapy care group (EEPC group; n = 39) and a conventional physiotherapy care group (CPC group; n = 39). Treatment protocol for the EEPC group included ≤3 Mets of physical activity and respiratory physiotherapy on zero post-operative day and an extra physiotherapy session during the first three post-operative days, whereas the CPC group was treated with usual physiotherapy care after the first post-operative day. The length of hospital and intensive care unit (ICU) stay were set as the primary study outcomes, while pre- and post-intervention measurements were also performed to assess the oxymetric and hemodynamic influence of early mobilization and physiotherapy. Results: Participants’ mean age was 51.9 ± 13.8 years. Of them 48 (61.5%) underwent CABG. Baseline and peri-procedural characteristics did not differ between the two groups. The total duration of hospital and ICU stay were significantly higher in the CPC group compared to the EEPC group (8.1 ± 0.4 days versus 8.9 ± 0.6 days and 25.4 ± 3 h versus 23.2 ± 0.6 h, p < 0.001, respectively). Statistically significant differences in pre-intervention oxygen saturation, and post-intervention PO2 and lactate levels were also observed between the two groups (p = 0.022, 0.027 and 0.001, respectively). Conclusion: In on-pump cardiac surgery, early and enhanced post-procedural physical activity (≤3 METS) can prevent a prolonged ICU stay and decrease the duration of hospitalization while ameliorating post-operative hemodynamic and oxymetric parameters.

Effect of Prone Positioning on Oxygen Saturation in COVID-19 Patients in Sri Aurobindo Hospital, Indore

Background: Physiotherapeutic intervention body positioning have been observed to increase oxygen saturation. In COVID-19 patients, we intended to investigate how the prone position worked in conjunction with conventional respiratory physiotherapy. The objective was to determine the effect of prone position along with conventional respiratory physiotherapy on SpO2 of COVID-19 patients in Aurobindo hospital, Indore district. Methods: The Ministry of Health, Government of India, authorized the rules for collecting data from infected patients. In this study, 400 patients between the ages of 20 and 80 years old were recruited from Sri Aurobindo Hospital in the Indore district, all of them had a confirmed diagnosis of COVID-19 and required oxygen treatment. SpO2 data was collected as a baseline. Patients were helped into the prone position after baseline data collection and conventional respiratory physiotherapy. Clinical data was obtained again after using the prone posture in conjunction with conventional respiratory physiotherapy. To demonstrate the various prone variations, a patient information sheet was supplied. At 0 and 60 minutes after the exercise, oxygen saturation was measured. Results: Between April 2020 to June 2020, we assessed SpO2 of 400 Patients pre and post prone position along with conventional respiratory physiotherapy. Prone positioning was feasible. Oxygenation was significantly improved from supine to prone position. The data were processed for mean and standard deviation. It was analyzed that there was difference in pre to post value of mean, from 95.685 to 98.123 with standard deviation from 1.645to 1.445. The result shows significant improvement in SpO2 after applying prone positioning in patients infected with COVID-19. The findings suggest that prone positioning is both possible and beneficial in increasing blood oxygenation in awake COVID-19 patients. Further study is needed to find the technique's potential value in terms of enhancing overall respiratory and global outcomes. Conclusion: The difference between the saturation of the two position was significant.

Efficacy of Early Respiratory Physiotherapy and Mobilization After on-pump Cardiac Surgery: a Prospective Randomized Controlled Trial

Objective: This randomized controlled trial aimed to investigate the influence of physical activity and respiratory physiotherapy on zero postoperative day on clinical, hemodynamic and respiratory parameters of patients undergoing cardiac surgeries under extracorporeal circulation.Methods: 78 patients undergoing coronary artery bypass graft (CABG) or/and valvular heart disease surgeries were randomly assigned into active physiotherapy group (APG; n=39) and conventional physiotherapy group (CPG; n=39). Treatment protocol for APG included ≤3 Mets of physical activity and respiratory physiotherapy on zero post-operative day and an extra physiotherapy session during the first three post-operative days, whereas CPG was treated with usual physiotherapy care after the first post-operative day. The length of hospital and intensive care unit (ICU) stay were set as the primary study outcomes, while pre- and post-intervention measurements were also performed to assess the oxymetric and hemodynamic influence of early mobilization and physiotherapy. Results: Participants’ mean age was 51.86 ±13.76 years. Of them 48 (61.5%) underwent CABG. Baseline and peri-procedural characteristics did not differ between the 2 groups. The total duration of hospital and ICU stay were significantly higher in the CPG compared to the APG (8.1±0.4 versus 10.2±0.6 days and 32.1±1.7 versus 23.2±0.6 hours, p<0.001, respectively). Statistically significant differences in pre-intervention oxygen saturation, and post-intervention PO2 and lactate levels were also observed between the 2 groups (p=0.022, 0.027 and 0.001, respectively). Conclusion: In on-pump cardiac surgery, early and active post-procedural physical activity (≤3 METS) can prevent prolonged ICU stay and decrease the duration of hospitalization whilst ameliorating post-operative hemodynamic and oxymetric parameters.

The Role of Physiotherapy in Pediatric Palliative Care: A Systematic Review

Pediatric palliative care (PPC) is a set of actions aimed at children who suffer from a severe or life-threatening disease to alleviate the symptoms of the disease and improve the quality of life of both the child and his/her family. One of the tools used to control symptoms is physiotherapy; however, its application in the child population has not been thoroughly studied. The main objective of this study was to gather, analyze, and critically evaluate the available scientific evidence on physiotherapy in children who require palliative care through a systematic review of the studies published in the last 10 years in the following databases: PubMed, Cochrane Library, PEDro, CINAHL, and Scopus. Of a total of 622 studies, the inclusion criteria were only met by seven articles, which were focused on the relationship between physiotherapy and PPC. This study analyzed: (1) the main pathologies treated, with a predominance of cerebral palsy and cancer; (2) the interventions applied, such as respiratory physiotherapy, neurological physiotherapy, therapeutic massage, and virtual reality; (3) the effects achieved in the child and his/her family, highlighting the control of symptoms and the improvement of the quality of life; and (4) the knowledge of the physiotherapists on PPC, observing that most of the professionals had not received training in this scope. The findings of this review indicate a lack of an adequate evidence foundation for physiotherapy in PPC.