Questions
~2 questions per BPT paper
Difficulty
Medium
Importance
Core topic for clinical rotations and final year theory
Overview
Perioperative physiotherapy in cardiothoracic surgery focuses on optimizing respiratory function before surgery and preventing complications like atelectasis or pneumonia afterward. Mastery of this topic is essential for both theory exams and clinical vivas, as it directly impacts patient survival and recovery times. Aspirants must grasp the transition from prophylactic breathing exercises to early progressive mobilization.
Pre-Operative Chest Physiotherapy
Pre-operative intervention aims to increase the patient's functional reserve and educate them on post-operative techniques to ensure compliance. It involves assessing baseline lung function and teaching maneuvers that will be required immediately after extubation.
- Assessment of lung fields via auscultation and spirometry
- Instruction on Deep Breathing Exercises (DBE) and incentive spirometry
- Teaching effective cough techniques like huffing to prevent fatigue
- Smoking cessation counseling at least 2 weeks pre-op
- Demonstration of post-operative bed mobility and limb exercises
Immediate Post-Operative Management (Phase I)
This phase focuses on airway clearance and preventing pulmonary complications while the patient is recovering from anesthesia. Emphasis is placed on stabilization and monitoring hemodynamic status during physical activity.
- Early mobilization within 24 hours of extubation
- Supportive cough techniques using a pillow for sternal splinting
- Active range of motion (AROM) for extremities to prevent DVT
- Monitoring oxygen saturation and ECG during bedside sitting
- Positioning to optimize ventilation-perfusion (V/Q) matching
Progressive Mobilization Protocols
Progressive mobilization is a graded increase in physical activity aimed at restoring functional independence and aerobic capacity. Protocols must be tailored to the patient's post-surgical sternal stability and cardiac output response.
- Gradual progression from sitting to standing and walking
- Monitoring Heart Rate (HR) and Blood Pressure (BP) responses to activity
- Strict adherence to sternal precautions for 6–8 weeks
- Energy conservation techniques for activities of daily living
- Introduction of low-intensity aerobic conditioning as tolerated
Exam Tip
Always link your PT intervention to specific patient outcome goals like 'preventing atelectasis' or 'reducing ventilator dependency' to score maximum marks.
Common Mistakes
- Failing to mention sternal precautions, which are mandatory in any cardiothoracic surgery viva.
- Confusing deep breathing exercises with incentive spirometry during the acute phase.
- Ignoring the hemodynamic monitoring requirements during the early mobilization phase.
More Revision Notes
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