Physiotherapy management following coronary artery surgery

Abstract

The physiotherapy management of 145 consecutive males undergoing elective coronary artery surgery (CAS) was investigated by means of a prospective survey. Physiotherapy treatment techniques were performed in only 13 patients (9%) during the period of intubation. Following extubation, thoracic expansion exercises (TEEs) were not included in the post-operative physiotherapy care of 132 patients (90%). The standard regimen consisted of positioning to optimise gas exchange, clearance of excess bronchial secretions using cough and the forced expiration technique (FET) with wound support, maintenance of joint mobility, early ambulation and advice regarding the resumption of functional activities.

The proportion of patients in a high-risk category for the development of post-operative respiratory complications was similar to that of patients in a previous study, which showed that additional breathing exercises were of no benefit to a regimen of mobilisation and instruction in huffing and coughing (Jenkins et al, 1989a). The present study found that although the usage of both internal mammary arteries and the right gastroepiploic artery as conduits has significantly increased since this time, few patients were deemed to require additional physiotherapy above mobilisation and cough and FET with wound support and the incidence of post-operative chest infection (5 patients, 3.4%) remained low.