A randomised controlled trial for the effect of preoperative physiotherapy in patients with an increased risk for the development of postoperative pulmonary complications after open-heart surgery.

Open-heart surgery implies both long-time general anaesthesia and comprehensive intrathoracic manipulations. This has negative effects on the respiratory system and especially on the pulmonary functions.
One of the main effects of this interference is a significant increase of developing of postoperative pulmonary complications (PPCs). PPCs are the main cause of postoperative mortality and morbidity. Depending on the definition the incidence of PPC after open-heart surgery varies between 7.5% (pneumonia) and 80% (atelectasis). Prevention of PPC is a primary aim of the care, part of which is the clinical physiotherapy.
For the prevention of PPC the physiotherapist has different interventions at his or her disposal. However, scientific studies show that physiotherapeutic interventions have only limited effects when they are only post-operatively executed on OHS patients that already developed a PPC. This is in contrast to preventive, pre-operative, physiotherapeutic interventions, that seem to have a protective effect in relation to the prevention of PPCs.
In practice, the employment of physiotherapeutic interventions before an OHS is more the exception than the rule, however. This study focused on this situation und investigated the effect of preoperative physiotherapy on the prevention of PPC after OHS.

Preoperative physiotherapy decreased the incidence of postoperative pulmonary complications (PPCs) after open heart surgery on patients with an increased risk of developing PPCs.

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The pre-operative physiotherapy consists of a combination of respiratory exercises involving the costo-diaphragm breathing technique, training of the inspiratory muscles for strength and endurance, and teaching a good technique for coughing and “forced expiration techniques”. The method, involving a progressive training course, is initiated 4 weeks before the operation.
The training period and progress of the training are sufficient to improve the strength and endurance of the respiratory musculature (also: accessory respiratory muscles).
Neuromuscular changes are especially important to increase the efficiency of breathing by the OHS patient. Exercise periods lasting 20 minutes are conducted once per day seven days each week.
The therapy is continued by the patient at home, once per week under the supervision of a physiotherapist and 6 times per week alone. During the supervised training at the beginning and at the end of the period of application, the heart rate and the blood pressure are measured to determine the cardiovascular stress.
In addition the patient keeps a diary, in which he notes the number of exercise sessions completed per week, the duration of each session, and the subjectively experienced stress. In the diary, space is provided for notes regarding physical complaints and problems that occurred before, during or after the exercises.