pneumonectomy

pneumonectomy

1. CENTRE OF PHYSIOTHERAPY AND REHABILITATION, JAMIA MILLIA ISLAMIA, NEW DELHI - 110025 PNEUMONECTOMY Presented by ; AL-AFSHAN Presented on ; 31 st – December - 2020

2. It is a surgical procedure that involves complete resection of a lung. INDICATIONS ; Lung carcinoma bronciectasis Lung infections such as tuberculosis INCISION ; posterolateral thoracotomy TYPES ; Standard pneumonectomy Removal of entire lung Radical pneumonectomy Removal of entire lung as well as part of pericardium, diaphragm and pleura

3. COMPLICATIONS ; Respiratory Infection of lung tissue Consolidation Broncho-pleural fistula Post pneumonectomy syndrome empyema Phrenic nerve damage Recurrent laryngeal nerve damage Circulatory Deep vein thrombosis Atrial fibrillation Hemorrhage Increased ventricular failure Cardiac herniation Wound infection Postural deformity scoliosis

4. PRE-OPERATIVE PHYSIOTHERAPY GOALS Gain patient’s confidence Clear the lung fields Teach respiratory control and inspiratory holding Teach postural awareness Teach arm, trunk and leg exercises Teach bed mobility INTERVENTIONS Teaching the exercises that has to be done post operatively and answer the patient’s question to gain patient’s confidence Chest PT should be done, if necessary to clear secretions Teach huffing maneuver and relaxation procedures Instruct the patient how to support wound during huffing or coughing perform active cycle of breathing technique (ACBT) after clearing lung fields

5. POST-OPERATIVE PHYSIOTHERAPY GOALS Clear secretion from the remaining lungs Retain full expansion of remaining lung tissue Prevent circulatory complications Prevent wound complications Regain arm and spinal movement Maintain good posture Restore exercise tolerance INTERVENTIONS At the day of operation TENS ( 15-20 min. after every 3 hours) Cryotherapy over the incision dressing Wound support during huffing or coughing manuevere Positioning Patient in semi-fowler position with the head and back supported with the pillow and both the forearms over the lap on a pillow Thoracic expansion exercises Breathing control with lateral costal expansion (max. insp – 3-5 sec hold , exp to end-tidal volume) Foot and ankle exercises

6. Day 1 post-operatively ( 4-5 sessions ) Side lying – chest expansion exercises on remaining side Postural drainage, if necessary huffing and expectoration with passive wound support ACBT Nebulizer therapy and humidification therapy Foot and ankle exercises Isometric quadriceps strengthening Posture correction should be emphasized to prevent scoliosis on scar side Neck exercise Assisted arm movement in functional pattern twice a day Provide a rope ladder to the patient so that patient can pull on it to move around the bed and sit.

7. Day 2 post-operatively Continue the above treatment Active wound support Sitting on the edge of the bed Trunk turning Trunk bending side to side Trunk stretching backward Sitting in chair Incentive spirometry Deep diaphragmatic breathing exercises Walking round the bed with trunk erect and arm swinging. Day 3 post-operatively Breathing exercises and huffing if required. Continue all of the above exercises twice a day Aerobic exercises The patient may join group therapy

8. Day 4 post-operatively to discharge group therapy should be continued Practice stair climbing along with breathing control exercises after the 7 th day Diaphragmmatic breathing exercises Trunk and arm exercises Remove the stitches at 7 th -10 th day of operation usually The patient should be discharged after 2 weeks Inspiratory muscle training Home exercise programme deep breathing exercises Gradual walkin programme Perform ADLs Practice ACBT wherever necessary Aerobic exercises using cycle ergometer

9. REFERENCES Essentials of Physiotherapy after Thoracic Surgery: What Physiotherapists Need to Know. A Narrative Review [ Korean J Thoracic Cardiovascular Surgery -2018] Dean ,E & Frownfelter , D. Cardiopulmonary physical therapy ; ( 3 rd ed ) Hough, A . physiotherapy in respiratory care ; (3 rd ed ) Downie , P, A. Cash’s Textbook Of Chest, Heart And Vascular Disorders For Physiotherapists ; ( 4 th ed )