The Impact of Chest Physiotherapy Technique (CPT) on Respiration, Pain and Quality of Life Post Thoracic Wall Fixation Surgery among Flail Chest Patients (FC)

Hanan Gaber Mohamed^1, , Eslam I. Ragab², Mohamed Abdel Bary³, Mahmoud Elshazly⁴, Ahmed Fathy Abdel Latif⁵ and Morris Beshay MD⁶

¹Medical Surgical Nursing Department, Faculty of Nursing, Benha University, Egypt

²Adult Medical Surgical Nursing Department, Faculty of Nursing, South Valley University, Qena, Egypt

³Cardiothoracic Surgery, Qena Faculty of Medicine, South Valley University, Egypt

⁴Physical Therapy Department, Faculty of Physical Therapy South Valley University, Qena, Egypt

⁵Anesthesia and ICU, Faculty of Medicine South Valley University

⁶Evangelic Clinic Bethel, Hospital University, Germany

Cite this paper:
Hanan Gaber Mohamed, Eslam I. Ragab, Mohamed Abdel Bary, Mahmoud Elshazly, Ahmed Fathy Abdel Latif and Morris Beshay MD. The Impact of Chest Physiotherapy Technique (CPT) on Respiration, Pain and Quality of Life Post Thoracic Wall Fixation Surgery among Flail Chest Patients (FC). American Journal of Nursing Research. 2018; 6(6):471-483. doi: 10.12691/ajnr-6-6-15

Abstract

Background: FC is the most extreme type of blunt chest wall casualty with death rate up to 20%. These patients may require prolonged days of mechanical ventilation for ongoing respiratory dysfunction, leading to high rates of pulmonary complications. This study aimed to assess the impact of CPT on respiration, pain and quality of life post thoracic wall fixation surgery in Flail Chest Patients. It followed a quasi-experimental, pretest-posttest comparison. The study was carried out in cardiothoracic surgery intensive care unit (ICU) at Qena university hospital. A convenience sample comprised of 30 adult patients from both sexes with flail chest and no contusion. They were given pharmacological epidural and oral analgesic medications to reduce pain during physiotherapy practice post chest stabilization surgery. Tool 1: A self-reporting Assessment Questionnaire were comprised pain rating index scores pre and post CPT and prior epidural analgesic administration, and symptoms associated with pain, Health-related quality of life and Dyspnea scale. Sociodemographic characteristics were attached to the tool 1. Tool 2: A clinical data base assessment were taken pre and post CPT, included: Part I: Laboratory investigation of a Standardized lung function tests which Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1) and Peak Expiratory Flow (PEF) were recorded and ABGs includes PaO2, PaCo2, SO2, and PH in addition to vital signs ( Part II) and Diagnostic test assessment includes Chest x-ray, and chest tomography CT was done before chest stabilization surgery to confirm the diagnosis in accordance of study criteria(Part III). Tool 3: CPT include, breathing and coughing exercise and IPPB., secretion mobilization techniques like chest wall percussion, and vibration and incentive spirometer. Results/conclusion: the majority of the studied sample was male and were from 50 - 60 years and illiterate. The effect of CPT on the symptoms associated pain, and pain intensity were still persistent in decrease post discharge at late follow up till 6^th month. The majority of subjects had no dyspnea on 3^rd and 6^th month of follow up. so, their HRQOL scores improved with a high significance in the area of mobility, self-care, anxiety and depression, the performance of usual activities and pain and discomfort on 6 months of late follow-up. Also, it was noticed that the mean of Pulmonary Function Test (PFT), and ABGs improved in the late follow-up. This improvement has been definitively shown in all outcomes parameter post chest physiotherapy performed after surgical fixation of FC. Recommendation: Moreover, this study recommended that all the physiotherapy approaches should be planned and applied as an individual programs tailored to the FC patients following a comprehensive evaluation.

Keywords:
flail chest physiotherapy pain Health-related quality of life Dyspnea

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