Physiotherapy and Rehabilitation

Biography

Biography: Maneesha S Deshpande

Abstract

Cardiovascular Disease (CVD) remains a major cause of health loss for all region of the world. In 2015, there were an estimated 422.7 million cases of cardiovascular disease and 17.92 million cardiovascular deaths. There were 110.55 million prevalent cases of Ischemic Heart Disease (IHD) with 8.92 million deaths. Rheumatic Heart Disease (RHD) was the fifth highest ranked CVD cause of DALY (Disability-AdjustedLife-Years). In India, with an estimated population of 1.3 billion people, deaths due to CVD are 28.1% with 14.1% of DALY. DALY rates for IHD increased nine times while for RHD increased four times in just 25 years. CABG is the most commonly offered treatment for IHD while valve repairs/ replacement for RHD. The pulmonary complications such as atelectasis are seen on postoperative chest radiographs in approximately 50% to 90% of patients with incidence of postoperative pneumonia being 3.1%. The role of physiotherapist is significant in preventing post-operative pulmonary complications. Preoperative physiotherapy education has shown many advantages like anxiety reduction, good rapport with the patient leading to early recovery and reduction in postoperative pulmonary complications. Deep Breathing and Coughing (DB&C) Sustained Maximal Inspiration (SMI), Incentive Spirometer (IS), Manual Therapy (MT) and early mobilization are the commonest modalities used while addition of Intermittent Positive Pressure Breathing (IPPB), Continuous Positive Airway Pressure (CPAP) in high risk cases (Prolonged ventilatory support, elderly and patients with high frailty index, pre-operative pulmonary complications, Low Ejection Fraction (EF), poor nutritional state, re-intubation and difficult-to-wean from ventilator cases). Physiotherapist is an integral member of the perioperative cardiac surgical team which facilitates smooth recovery after cardiac surgery. A sound knowledge of pulmonary physiology and its derangement due to pre-operative valvular disease or IHD with reduced EF need to be understood. A vigilant watch by the physiotherapist on any adverse pre-operative and perioperative events helps to modify the post-operative physiotherapy program.