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Preoperative Physical Therapy Medisch Fysioloog - Fysiotherapeut

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Presentation on theme: "Preoperative Physical Therapy Medisch Fysioloog - Fysiotherapeut"— Presentation transcript:

1 Preoperative Physical Therapy Medisch Fysioloog - Fysiotherapeut
. Dr. HJ (Erik) Hulzebos Medisch Fysioloog - Fysiotherapeut UMC Utrecht. Page 1

2 Ontwikkelingen peri-operatieve zorg
Verschuiving naar preoperatieve zorg Kortere opnameduur Multidisciplinaire screening Coördinerende rol anesthesisten Fysiotherapie? Gezondheidsraad: Commissie Preoperatief onderzoek. Preoperatief onderzoek. Gezondheidsraad, Rijswijk; Report No.: Nr 2. The effect of national guidelines on the implementation of outpatient preoperative evaluation clinics in Dutch hospitals. Eur J Anaesthesiol 2006 Nov;23(11):


4 Lung function impairments are multifactorial
Anaesthesia Cardiopulmonary bypass Surgery itself Analgesia Postoperative immobility

5 Functieverlies tijdens ziekenhuisopname
Beademing The combination of 18 to 69 hours of complete diaphragmatic inactivity and mechanical ventilation results in marked atrophy of human diaphragm myofibers. Levine S, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med Mar 27;358(13): 5

6 Mechanical Ventilation
Oxidative Stress Protein Degradation Rapid Atrophy

7 Case: hrs MV Control: 2 – 3 hrs MV 57% ↓ CSE ST-fibers 53% ↓ CSE FT-fibers


9 Consequentie daling LF & Ademspieren
Atelectase Vermindering van expiratoire flow Minder goed hoesten (ACT) Hypoxie (ventilatie/perfusie mismatch) Slijmtransport  Risico pulmonale complicatie 

10 PPC’s in CABG surgery

11 Predictors of pneumonia

12 Predictors of hospital stay

13 + Rationale Cardiac Surgery Intervention Respiratory muscles 
Mucus clearance  Longfunctions  + Respiratory Muscle training Breathing Exercises ACT Risk PPC’s  Hulzebos et al. JAMA 2006;296:

14 Valkenet, van de Port, Dronkers, de Vries, Lindeman and Backx






20 Respiratoire Functies
PCF Hulzebos & Dronkers, 2012

21 Vragen Thanks for your attention and there now time for some questions.

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