Principles of early respiratory physiotherapy of cardiacpatients after heart surgeries in MTO.

Overview

Physiotherapy after heart surgery focuses on provision of respiratory comfort of the patient, relaxationof postoperative respiratory rigidity and on reduction of the sensation of “thoracic armour” in patientsafter longitudinal sternotomy. Respiratory physiotherapy emphasizes principles of linearity duringslow breathing (so-called principle of velocity). Special expectoration techniques are used (Airwayclearance techniques), such as static breathing techniques, postural drainage (according to Chevaillier)and energy conserving controlled cough (huffing). After initial assisted breathing with the useof localized breathing and inhalation therapy, treatment progresses to resisted breathing. Firstly,resisted inspiration is practiced (with the device TRIFLO), then mainly resisted expiration with theuse of positive expiratory pressure system with oscillation breathing (PEP devices). Physiotherapyafter sternotomy starts with abdominal breathing and gradually adds costoabdominal and costalbreathing.We utilize the dynamics of thoracic spine as well as upper extremities (dynamic breathingtechniques). Very important is fitness training with breathing exercises and subsequent regularrelaxation with the use of autogenic training.

Key words:
longitudinal sternotomy, postoperative respiratory rigidity, principles ofvelocity, linearity of breathing, assisted breathing, postural drainage, huffing, localized breathing,