Search

Introduction: Patients who undergo heart surgery with a diagnosis of chronic obstructive pulmonary disease (COPD) can more easily develop pulmonary dysfunction in the sense of an acute exacerbation of COPD, defined as worsening dyspnea, increased volume and infection of sputum, increased cough, increased breathing frequency, or heart rate.1 All the listed symptoms represent a postoperative complication and cause the need for more intensive help and specific treatments. Over the years, different strategies have been developed for lung rehabilitation. The clinical application of early respiratory therapy with all related techniques, in combination with inhalation and other pharmacological therapy, can influence the positive outcome of the patient’s recovery.2 Case report: A patient with coronary heart disease and COPD was selected from the register of the Institute for Cardiac and Transplantation Medicine, University Hospital Dubrava, who developed symptoms of exacerbation of COPD after heart surgery in the period from September 5 to September 22, 2023. The analysis included the influence of Cipla inhalation therapy and early respiratory therapy on the implementation of the respiratory program and the results of the patient’s respiratory status. Postoperative exacerbations of COPD were recorded in the patient within 72 postoperative hours. Clinical signs were worsening dyspnea, infectious secretions, and an increased respiratory rate. Radiological and laboratory findings showed a specific pattern of exacerbation. Prescribed inhalation therapy with Cipla x6 over 24 hours or 3 days, later x4 or 4 days, bronchodilators, and increased lung rehabilitation 3x a day improved the patient’s respiratory status. Conclusion: Timely treatment of acute exacerbations of COPD after cardiac surgery with increased use of inhalation therapy in combination with respiratory therapy can stabilize the patient and reduce lung respiratory dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Heart failure is a chronic, progressive condition in which a heart muscle cannot pump enough blood through the heart to meet the blood and oxygen requirements of the body.1 It is the result of numerous primary and secondary diseases that lead to impaired heart pump function and reduced heart rate. Recognizing symptoms and establishing diagnosis is an extremely important part of the treatment and therapy of such patients. Through all forms of treatment of such patients, clinically, medically and ultimately surgically, physiotherapeutic processes are present as important factors in the medical team. Methods of monitoring, evaluation and physiotherapeutic intervention itself are performed and recorded in a standardized physiotherapeutic card and qualified questionnaires. The left ventricle assists device (LVAD) is mechanical support that is surgically embedded. It helps maintain the ability of a heart pump that cannot function independently. The LVAD device, sometimes referred to as the "bridge for transplantation", is now used in longterm therapy. People often have to wait a long time before the appropriate heart becomes available. During this waiting, the already weakened heart of the patient may become even worse. Case report: A case study of a patient with diagnosis of dilated cardiomyopathy, received through Emergency services, continuation of treatment in the Coronary Unit, Intensive Care Unit and ultimately at the Institute for Cardiac and Transplant Surgery. Because of the underlying disease, the patient was connected to the extracorporeal membrane oxygenation device, and LVAD was later embedded into the operation. Outstandingly bad respiratory and condition status, physiotherapeutic intervention started in the intensive care unit and continued in the department. After a series of complications, the patient with that has undergone frequent early rehabilitation for 3 months has left our clinic and managed to proceed with daily life activities completely independent. She is currently on the transplant list. Conclusion: Given the difficult diagnosis, our patient has been able to overcome all the complications occurring in such a difficult state with the help of the built-in LVAD. A series of respiratory and musculoskeletal complications during surgical treatment required special expertise and knowledge of physiotherapists who, through their physiotherapeutic processes, helped the patients to re-actively engage in everyday lifestyle rhythm. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease (COPD) develops and progresses over the years. Disease characterized by productive cough, dyspnea, hypoxemia and hypercapnia presents a high risk of development of postoperative pulmonary complications in patients after cardiac surgery. 1,2 Repeated endotracheal intubation is neither good nor desirable option therefore physiotherapy respiratory treatment and non-invasive ventilation (NIV) in any form is strongly recommended.3 Objective: To show effectiveness of high flow oxygen therapy using physiotherapy respiratory treatment and AIRVOTM 2 device with nasal cannula in patient with poorly managed COPD who developed postoperative pulmonary complications after cardiac surgery. Case report: This case report presents an example of twenty days treating a patient who had clinically documented acute exacerbation of COPD following cardiac surgery. Respiratory distress, hypoxemia and moderate to severe hypercapnia were developed. In similar patients, along with early respiratory physiotherapy, NIV has become preferred modality of respiratory support because it increases tidal volume, maintains adequate alveolar ventilation, washes out carbon dioxide, reduces the work of breathing and eliminates majority of anatomical dead space. Chosen form of NIV is relatively new method of respiratory support using AIRVOTM 2 device. SPO2 and gasses O2 and CO2 from arterial blood parameter were compared before starting therapy and after few hours. High flows of heated and humidified mixture of air and oxygen delivered through nasal cannula resulted in significantly better and faster recovery of above mentioned patient. Conclusion: After several days of treatment with this method, patient was discharged home in stable cardiorespiratory condition with significant improvements in pulmonary and hemodynamic parameters. Implementation of adequately titrated high flow oxygen therapy with early respiratory physiotherapy treatment played an important role in successful recovery. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Cardiac surgical procedures and other forms of surgical procedures are the interventions that include the appearance and occurrence of pain of sensitive structures. Almost everyone feels pain after surgery. Pain is common, continuous, intermittent, sharp, shooting, dull... It increases in case of movement by a person, in case of coughing, shallow or deep breathing. Pain syndromes that occur after cardiac surgical procedures may be multiple, of visceral, musculoskeletal or neurogenic origin. Risk factors for the occurrence of such a pain are the age of a patient, a length and a type of surgical procedure and other unforeseen postoperative events. After the surgical procedure, opioid analgesics are normally prescribed which are the most efficient as the pharmacological approach to the treatment of acute pain. Physiotherapy procedures are to be conducted already in the intensive care unit as a non-pharmacological but effective approach to the treatment of pain. OBJECTIVE: To describe the characteristics of a pain, its intensity, location and its distribution after the cardiac surgery and the possibility of conducting physiotherapy procedures in a combination with the pharmacologic therapy. METHODS: The study was conducted at the Department of Cardiac and Transplant Surgery, University Hospital Dubrava, for two months on a sample of 250 patients. A structured questionnaire was used for the trial. The intensity of the pain by using a verbal rating scale, monitor and visual analogue scale for pain (VAS), pain location and spread of pain was tested from the first to the tenth day after the surgery by using the image of anatomical body divided into 32 numbered regions. RESULTS: The results of the trial showed that the intensity and location of the pain in the first postoperative days in the region of the chest and upper abdomen is the highest with the rating scale 8, max. zone of pain (3-7 days) in the regions 5, 7, 9, 11. In later postoperative days the pain by VAS ranges from 0-3, and the max. zone of pain (from 7-10 days) in regions 25, 23, and 6. Physiotherapy was conducted on a daily basis in a combination with pharmacological preparations. CONCLUSION: The results showed us that we must not minimize the importance of a phenomenon of pain after the surgery and we should appreciate it as a valuable outcome of the surgical procedure. The proper detection of intensity, place, location and duration of pain will help us be better experts in providing comprehensive recovery of our patients by using both pharmacological and nonpharmacological approach as a good combination. [ABSTRACT FROM AUTHOR]