Prophylactic respiratory physiotherapy after cardiac surgery: systematic review
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7428.1379 (Published 11 December 2003) Cite this as: BMJ 2003;327:1379All rapid responses
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To: Elizabeth M Ashley,
Over the past 23-years that I have been a practicing Respiratory
Therapist, I have seen modes and methods of physiotherapy come in and out
of favor. I must say that Chest Physiotherapy (percussion with a cupped
hand accompanied by postural drainage) and Intermittent Positive Pressure
Breathing (IPPB) are two therapies that I do not miss. In the USA, these
therapies have fallen significantly out of favor, being replaced with less
costly, equally efficient, therapies.
I would never say that Chest Physiotherapy and Intermittent Positive
Pressure Breathing would impede in a patients successful recovery but I
can without a doubt say that recovery is possible without these therapies.
Taking into account average lengths of stay and post-operative
complications, patients in the USA recovery successfully without these out
-dated modes of therapy.
I have always thought a large scale evaluation using a double blind
control method would (scientifically, once and for all) prove these
therapies unnecessary. The truth is we have already proven this by no
longer providing these modalities. Our average length of stay continues to
grow smaller.
Competing interests:
None declared
Competing interests: No competing interests
I am just wondering why Dr Elizabeth Ashley FRCA (consultant Cardiac Anaesthetist) and Gunnilla Jungqvist (Senior Physiotherapist) of The Heart Hospital, Westmoreland Street, London W1M 8PH said that the systematic review by Pasquina et al (2003)on Prophylactic respiratory physiotherapy after cardiac surgery illustrated "the shortfalls of meta-analysis as a research technique, combining results from small under-powered studies, the majority of which were non-randomised and uncontrolled" when Pasquina et al (2003) stated that they used randomised trials only.
I'm trying to review this area and this caught my attention.
Thank You for reading this,
Ruth Purcell.
Competing interests:
None declared
Competing interests: No competing interests
Sir,
Prophylactic respiratory physiotherapy after cardiac surgery:
systemic review
This review only serves to illustrate the shortfalls of meta-analysis
as a research technique, combining results from small under-powered
studies, the majority of which were non-randomised and uncontrolled.
Making such conclusions about a technique from such poor evidence is both
dangerous and misleading. Physiotherapy has an integral role in early
extubation and fast track programmes and the single most important aspect
of this is rapid mobilisation supervised by the physiotherapist. This
improves functional residual capacity and respiratory function. Until a
large randomised controlled trial of the respiratory benefits of
physiotherapy post cardiac surgery has been carried out, it must not be
dismissed as a costly intervention, without benefit.
Yours faithfully,
Dr Elizabeth Ashley FRCA (consultant Cardiac Anaesthetist)
Gunnilla Jungqvist (Senior Physiotherapist)
The Heart Hospital,
Westmoreland Street,
London W1M 8PH
Competing interests:
None declared
Competing interests: No competing interests
Re: Don't write off physiotherapy after cardiac surgery
As a post graduate student in cardiopulmonary physical therapy and a
year service in the post cardiac care, i would like to add upon my
comments to Mr. Edward collier. Physiotherapy trials so far conducted in
the post op cardiac care might be of very small sample sizes and very few
randomised trials. But considering those trials, those authors attempted
to control every confounding factors that can influence the outcomes. And
most outcome measures in the cardiac care physiotherapy are subjective and
the few objective measures that are available are questioned for its
validity. But from 2005, standardisation of outcome measures by AHA and
ATS were worth appreciable. 2005 - review in chest on breathing exercise
on post cabg patients and pediatrics article that quote the benefit of
inpatient rehabiliattion in congenital heart diseases and 2006 / 2007 -
annals of cardiovasclar surgery articles are worth mentioning. since after
the review so many articles on post cardiac surgery physiotherapy are out,
an update/ a review should be done
Competing interests:
None declared
Competing interests: No competing interests