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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

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...

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Published: 2014
Institution: Swansea University
Degree level: Master of Philosophy
Degree name: M.Phil
URI: https://cronfa.swan.ac.uk/Record/cronfa42624
first_indexed 2018-08-02T18:55:09Z
last_indexed 2019-10-21T16:48:10Z
id cronfa42624
recordtype RisThesis
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spelling 2018-08-31T14:57:49.7464650 v2 42624 2018-08-02 To understand postoperative pulmonary complications so as to inform physiotherapy practice following adult cardiac surgery. e1ad1fa2c9c890f97f6dcc0fed74154b NULL Gemma Louise Chesterfield-Thomas Gemma Louise Chesterfield-Thomas true true 2018-08-02 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. E-Thesis Medicine.;Physical therapy. 31 12 2014 2014-12-31 COLLEGE NANME Swansea University Medical School COLLEGE CODE Swansea University Master of Philosophy M.Phil 2018-08-31T14:57:49.7464650 2018-08-02T16:24:29.8837969 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Gemma Louise Chesterfield-Thomas NULL 1 0042624-02082018162509.pdf 10805382.pdf 2018-08-02T16:25:09.1330000 Output 11826216 application/pdf E-Thesis true 2018-08-02T16:25:09.1330000 false
title To understand postoperative pulmonary complications so as to inform physiotherapy practice following adult cardiac surgery.
spellingShingle To understand postoperative pulmonary complications so as to inform physiotherapy practice following adult cardiac surgery.
Gemma Louise Chesterfield-Thomas
title_short To understand postoperative pulmonary complications so as to inform physiotherapy practice following adult cardiac surgery.
title_full To understand postoperative pulmonary complications so as to inform physiotherapy practice following adult cardiac surgery.
title_fullStr To understand postoperative pulmonary complications so as to inform physiotherapy practice following adult cardiac surgery.
title_full_unstemmed To understand postoperative pulmonary complications so as to inform physiotherapy practice following adult cardiac surgery.
title_sort To understand postoperative pulmonary complications so as to inform physiotherapy practice following adult cardiac surgery.
author_id_str_mv e1ad1fa2c9c890f97f6dcc0fed74154b
author_id_fullname_str_mv e1ad1fa2c9c890f97f6dcc0fed74154b_***_Gemma Louise Chesterfield-Thomas
author Gemma Louise Chesterfield-Thomas
author2 Gemma Louise Chesterfield-Thomas
format E-Thesis
publishDate 2014
institution Swansea University
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description 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.
published_date 2014-12-31T04:22:06Z
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score 11.090464

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