E-Thesis 78 views 48 downloads
To understand postoperative pulmonary complications so as to inform physiotherapy practice following adult cardiac surgery. / Gemma Louise Chesterfield-Thomas
Swansea University Author: Gemma Louise Chesterfield-Thomas
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Abstract
The development of postoperative pulmonary complications (PPC's) in patients undergoing cardiac surgery appears to require a more intensive service provision postoperatively and thus its impact on mortality and morbidity has been well recognised. Respiratory physiotherapy treatments aimed at im...
| Published: |
2014
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| Institution: | Swansea University |
| Degree level: | Master of Philosophy |
| Degree name: | M.Phil |
| URI: | https://cronfa.swan.ac.uk/Record/cronfa42624 |
| Abstract: |
The development of postoperative pulmonary complications (PPC's) in patients undergoing cardiac surgery appears to require a more intensive service provision postoperatively and thus its impact on mortality and morbidity has been well recognised. Respiratory physiotherapy treatments aimed at improving or restoring pulmonary function following surgery has the unique opportunity to effect the prevalence of PPC's. However, the identification of potential determinants for the development of PPC's after cardiac surgery appears to be multi-factorial There is therefore a rationale to gain a deeper understanding and examine the patient profile to identify characteristics that potentially influence the development of this complication and furthermore its impact on clinical outcomes. This knowledge could inform physiotherapy practice within cardiothoracic surgery by optimizing the management of patients identified as high risk for this complication in the fixture. Research Aim To examine the nature and identifiable causal factors of Postoperative Pulmonary Complications following adult cardiac surgery in order to inform physiotherapy practice in patients identified as high risk. Methods This thesis utilized a number of research methodologies to address the research aim: A Systematic Review of the literature was undertaken to critically appraise evidence relating to risk factors for the development of postoperative pulmonary complications. Subsequently, a Narrative Review evaluated PPC's in the wider context in addressing the impact on morbidity and mortality, whilst exploring the potential role of physiotherapy initiatives to address this complication. A local Service Evaluation was conducted via a retrospective audit to evaluate 736 consecutive adult cardiac surgical patients to describe the local population and investigate patient characteristics and explore trends relating to patient and performance outcomes. Conclusions On average, 20% of the cardiac surgical population will develop postoperative pulmonary complications which requires a significantly prolonged stay in intensive care (5.04 days vs. 0.4 days; p=0.001). Left Ventricular function was the isolated preoperative characteristic that potentially influenced the development of postoperative pulmonary complications. The future recommendations for physiotherapy services including preoperative screening and early intervention strategies utilising left ventricular function as a physiological measure to identify patients at risk have been presented. These physiotherapy strategies for informing change have the potential to avert this complication and could have a considerable impact on the cardiothoracic service as a whole. |
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| Keywords: |
Medicine.;Physical therapy. |
| College: |
Faculty of Medicine, Health and Life Sciences |