Preoperative Physical Therapy Dr. HJ (Erik) Hulzebos Medisch Fysioloog - Fysiotherapeut UMC Utrecht.

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Preoperative Physical Therapy Preoperative Physical Therapy Dr. HJ (Erik) Hulzebos Dr. HJ (Erik) Hulzebos Medisch F Medisch F ysioloog - Fysiotherapeut ysioloog - Fysiotherapeut UMC Utrecht. UMC Utrecht.

Transcript of Preoperative Physical Therapy Dr. HJ (Erik) Hulzebos Medisch Fysioloog - Fysiotherapeut UMC Utrecht.

Preoperative Physical Therapy Preoperative Physical Therapy

Dr. HJ (Erik) HulzebosDr. HJ (Erik) HulzebosMedisch FMedisch Fysioloog - Fysiotherapeut ysioloog - Fysiotherapeut

UMC Utrecht.UMC Utrecht.

Ontwikkelingen peri-operatieve zorg

Verschuiving naar preoperatieve zorg

Kortere opnameduurMultidisciplinaire screening Coördinerende rol anesthesistenFysiotherapie?

Gezondheidsraad: Commissie Preoperatief onderzoek. Preoperatief onderzoek. Gezondheidsraad, Rijswijk; 1997. Report No.: Nr 2.

The effect of national guidelines on the implementation of outpatient preoperative evaluation clinics in Dutch hospitals. Eur J Anaesthesiol 2006 Nov;23(11):962-70.

Lung function impairments are Lung function impairments are multifactorialmultifactorial

Anaesthesia

Cardiopulmonary bypass

Surgery itself

Analgesia

Postoperative immobility

Beademing

The combination of 18 to 69 hours of complete diaphragmatic inactivity and mechanical ventilation results in marked atrophy of human diaphragm myofibers.

Levine S, et al.Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans.N Engl J Med. 2008 Mar 27;358(13):1327-35.

Functieverlies tijdens ziekenhuisopname

Mechanical Ventilation

Oxidative Stress

Protein Degradation

Rapid Atrophy

Case: 18 - 69 hrs MV

Control: 2 – 3 hrs MV

57% ↓ CSE ST-fibers

53% ↓ CSE FT-fibers

Consequentie daling LF & Ademspieren

Atelectase Vermindering van expiratoire flow Minder goed hoesten (ACT)

Risico pulmonale complicatie

Hypoxie (ventilatie/perfusie mismatch)Slijmtransport

PPC’s in CABG surgery

Predictors of pneumonia

Predictors of hospital stay

Respiratory muscles

Mucus clearance Longfunctions

+

Rationale

Cardiac Surgery Intervention

Respiratory Muscle training

Breathing Exercises

ACT

Risk PPC’s Hulzebos et al. JAMA 2006;296:1851-1857

Valkenet, van de Port, Dronkers, de Vries, Lindeman and Backx

Respiratoire Functies

Hulzebos & Dronkers, 2012

PCF

Vragen