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

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Presentation on theme: "Preoperative Physical Therapy Dr. HJ (Erik) Hulzebos Medisch Fysioloog - Fysiotherapeut UMC Utrecht."— Presentation transcript:

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

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):

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

5 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): Functieverlies tijdens ziekenhuisopname

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

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

10 PPC’s in CABG surgery

11 Predictors of pneumonia

12 Predictors of hospital stay

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

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

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20 Respiratoire Functies Hulzebos & Dronkers, 2012 PCF

21 Vragen


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