Cardiac Rehabilitation Manual

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Chapter VII. Chapter VIII. Chapter IX. Chapter X. Index Tel 91 99 99 Fax 91 21 Etiquetas Halliday, J. CR services are generally provided in an outpatient setting as comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. While the "glue" of cardiac rehabilitation is exercise, programs are evolving to become comprehensive prevention centers where all aspects of preventive cardiology care are delivered.

Regarding the type of surgical procedure performed was the predominance of CRM and hospitalization time was The step program was an important to guide the work of therapy, and the steps have been evolving over the days postoperatively until hospital discharge and the most used step during the rehabilitation phase I was the Step 3. Therefore, this program can guide evolution by physical therapy rehabilitation in patients after cardiac surgery during hospitalization. The limitation of this study lies in being a retrospective study.

We suggest further studies with a prospective design and randomized clinical trials in order to show the effectiveness of cardiac rehabilitation program in postoperative cardiac surgery. The impact of social status inconsistency on cardiovascular risk factors, myocardial infarction and stroke in the EPIC-Heidelberg cohort. BMC Public Health. Quality of life after on-pump and off-pump coronary artery bypass grafting surgery.

Arq Bras Cardiol. Surgery for valvular heart disease: a population-based study in a Brazilian urban center. PLoS One. Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction.

The Benefits of Cardiac Rehabilitation

Cleve Clin J Med. Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev. Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial. Am J Phys Med Rehabil. Sociedade Brasileira de Cardiologia. Guidelines for cardiopulmonary and metabolic rehabilitation: practical aspects and responsibilities.

Umeda IIK. Regenga MM. Three physiotherapy protocols: effects on pulmonary volumes after cardiac surgery. J Bras Pneumol. Heart Views. Prophylactic respiratory physiotherapy after cardiac surgery: systematic review. Cardiac rehabilitation following percutaneous revascularization, heart transplant, heart valve surgery, and for chronic heart failure. The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery in Iran.

BMC Cardiovasc Disord. Physical therapy in postoperative cardiac surgery: patient's perception. Rev Bras Cir Cardiovasc. Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery. Arch Phys Med Rehabil.

Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery--a randomised controlled trial. Heart Lung Circ. Incentive spirometry with expiratory positive airway pressure brings benefits after myocardial revascularization. Branson RD. The scientific basis for postoperative respiratory care. Respir Care. Phase I of cardiac rehabilitation: A new challenge for evidence based physiotherapy. World J Cardiol. Arq Med ABC.

Phase II – Early Discharge Phase

E-mail: elianew unijui. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Services on Demand Journal.


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ABSTRACT Objective: To analyze a cardiac rehabilitation adapted protocol in physical therapy during the postoperative hospital phase of cardiac surgery in a service of high complexity, in aspects regarded to complications and mortality prevalence and hospitalization days. Methods: This is an observational cross-sectional, retrospective and analytical study performed by investigating 99 patients who underwent cardiac surgery for coronary artery bypass graft, heart valve replacement or a combination of both.

Results: In average, a patient stays for two days in the Intensive Care Unit and three to four days in the hospital room, totalizing six days of hospitalization. Conclusion: This evolution program by steps can to guide the physical rehabilitation at the hospital in patients after cardiac surgery. Received: November 12, ; Accepted: February 24, How to cite this article. Active stretching of lower limbs quadriceps, adductors, hamstrings and triceps. Data collection, analysis and interpretation of data, manuscript draft.

Currently cardiovascular disease CVD is a public health problem. According to the World Health Organization WHO , about 17 million people die annually from cardiovascular diseases [ 1 ]. Coronary artery bypass grafting is an effective alternative for the treatment of CVD, optimizing the prevention of acute myocardial infarction AMI , improved quality of life and delay death.

Likewise, surgical intervention is the treatment of degenerative rheumatic valvular heart disease [ 2 , 3 ]. However, cardiac surgery is a complex procedure that carries significant implications, both organic, and changes the patient's physiological mechanism, resulting in a higher incidence of complications that tend to significantly decrease the potential for recover [ 4 ]. Moreover, physiotherapy participates in the process of cardiac rehabilitation, pre and postoperative cardiac surgery, to contribute significantly to better prognosis, acting in the preoperative period with techniques aimed at the prevention and minimization of pulmonary complications, and in the postoperative period, with hygiene maneuvers and pulmonary expansion, to contribute on reducing the effects of time spent in bed and decrease the length of hospital sta [ 5 , 6 ].

Thus, cardiac surgery requires the work of a multidisciplinary team, and the physiotherapist is one of the professionals involved and of great importance in the rehabilitation process. According to the Guidelines for Cardiopulmonary and Metabolic Rehabilitation [ 7 ] cardiac rehabilitation should take place in phases.

Cardiac Rehabilitation

Phase 1 applies to inpatients, being the first step toward an active and productive life, which should predominate the combination of low-intensity exercise, techniques for stress management and education programs in relation to risk factors. The program aims at this stage that the patient is discharged with the best possible physical and psychological conditions, with all the possible information regarding healthy lifestyle.

Phase 2 starts after discharge and lasts three to six months, during this period the exercise program is individualized in terms of intensity, duration, frequency, type of training and progression, as well as constant monitoring, aiming to return to social and professional activities. The third phase lasts 6 to 24 months and may or may not be following the previous phase. The improvement of the physical condition is the main purpose, as well as improved quality of life.

The phase 4, following long-term programs, with the main objective of increasing and maintaining physical fitness. Activities are not necessarily supervised and should adequate time availability for the maintenance of physical exercise program and preference for recreational sporting activities. In this study, we discuss the phase I of cardiac rehabilitation in patients in the postoperative period PO of cardiac surgery. In the Literature it becomes clear protocols for cardiac rehabilitation during hospitalization deficit. There are protocols that demonstrate a progression in which individuals go through stages steps that evolve according to their recover [ 8 , 9 ] and others as a daily rehabilitation, adopting different therapeutic strategies in PO, both in cardiac rehabilitation after acute myocardial infarction as in the postoperative period of cardiac surger [ 10 , 11 ].

An example for postoperative care of cardiac surgery is proposed by Umeda [ 8 ] protocol that works as developing global Steps exercises, daily progression involving large muscle groups and stretches developed in 5 days. Other authors have also highlighted in phase I cardiac rehabilitation in other cardiac pathologies and similar to the postoperative cardiac surgical actions.

The protocol Babu et al. In rehabilitation in post-AMI, Regenga [ 9 ] adapted its protocol from the Emory University School of Medicine, occurring progression of 7 Steps to simultaneous work of motor and respiratory therapy. Currently, studies bring the effectiveness of physiotherapy techniques in phase I in the Literature, cardiac rehabilitation individualized [ 10 ] having so few studies that are directed to protocols with progression to hospital discharge in cardiac rehabilitation in postoperative cardiac surger [ 8 , 9 ].

This protocol is intended for patients after acute myocardial infarction [ 9 ] and adapted by the team to be performed in patients in the postoperative period of cardiac surgery.

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The adoption of a protocol ensured that the team could standardize care among professionals and conduct the registration of a comprehensive and systematic way activity. Therefore, the aim of this study was to analyze the adapted protocol for cardiac rehabilitation in physical therapy during the postoperative hospital stay PO of cardiac surgery in a service of high complexity, prevalence and complications in aspects of mortality and hospitalization days.

Data collection was conducted through research into patient charts, so it does not have any risk of damage, being subject to the secrecy of information. A total of records analyzed, 12 were eliminated from the sample because they belonged to individuals who died more than a year before the data collection, and they were in a position to inactive file or by not reporting on the program of Steps in hospital rehabilitation.

Data were analyzed from April to September Through an analysis of patient records, data collection was performed using a specifically designed form for this purpose, containing the variables for identifying individuals, clinical variables: family history of cardiovascular disease CVD , hypertension SAH diabetes mellitus DM , dyslipidemia, smoking, physical inactivity and stress and comorbid conditions: acute myocardial infarction AMI , chronic obstructive pulmonary disease COPD and surgical history.

The analyzed variables were intraoperative time of surgical procedure, duration of cardiopulmonary bypass CPB time, aortic clamping, recovery rate spontaneous or shock and type of drain used. In the postoperative period, the variables analyzed were duration of mechanical ventilation MV , length of stay in the coronary care unit CCU , days of hospital stay and total hospital days. Thus, physical therapy along with the team of professionals, adopted and adapted a cardiac rehabilitation program through steps Chart 1 from the protocol of cardiac rehabilitation after myocardial infarction [ 9 ].

The protocol is composed of seven progressive stages, with low intensity activities starting at 2 METs and reaching around 4 METs in the last step. It begins with early mobilization, followed by sedestation and active assisted or free standing position. Cardiac Rehabilitation Program consists of Steps adapted to postoperative cardiac surgery for patients in hospital phase I. Steps program adapted to patients in the postoperative period of cardiac surgery in phase I or hospital adapted from the Steps of Regenga program [9]. The progression of the intensity is made individually, following the program steps in which each Step is equivalent to a set of exercises at an intensity and repetition, wherein the energy consumption of each group are related in accordance with oxygen consumption required by the body for the task.

The physiotherapist opted by Step after performing the assessment to the bedside, observing the general condition of the patient and performed the medical record entries. By the time the analysis was performed physiotherapy twice a day. The adoption of this protocol by physiotherapy was performed at the time the service began and professionals performed the standardization of care, as well as a detailed record of the protocol in the medical record.

Cardiovascular Rehabilitation - Special Subjects - MSD Manual Professional Edition

This allowed the holding of a protocol analysis of cardiac rehabilitation, as well as it was possible to verify the postoperative complications, mortality and length of hospital stay in postoperative cardiac surgery. It is noted that the present study performed the analysis for a range of time of application. The variables were presented as absolute and relative, average, standard deviation and percentage frequencies. The study consisted of 99 patients undergoing cardiac surgery, with an average age of The predominant type of surgery was CABG The presence of cardiovascular risk factors and comorbidities have a high prevalence of cardiac patients.

Thus, it is observed that family history Among the comorbidities, AMI Table 1 shows the analysis of intraoperative and postoperative factors of patients undergoing cardiac surgery. On average it is two days in the ICU and three to four days in the room, with an average of six days in hospital. The PO mortality had a higher percentage in hospital and two years compared to 30 days after hospital discharge. Description of intraoperative and postoperative factors of patients undergoing cardiac surgery. To facilitate analysis, the complications of PO were divided into seven groups, they are the neurological complications psychomotor agitation, confusion and syncope , cardiovascular complications hypotension, tachycardia and cardiogenic shock , respiratory hemoptysis, pleural effusion, pleural fistula, pneumothorax, atelectasis, and reintubation , vascular complications ischemia and bleeding ; hemodynamic complications bleeding and thrombocytopenia , gastrointestinal complications nausea and vomiting , renal aerodynamics evaluation and oliguria.

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Table 2 shows all the complications that occurred in each PO, and hemodynamic and respiratory complications were the most prevalent. The discharge started from the fifth to the seventh postoperative day,