scandinavian conference in cardiothoracic surgery 2009 national guidelines for chest- and abdominal...
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Scandinavian Conference in Cardiothoracic Surgery 2009
National guidelines for chest- National guidelines for chest- and abdominal physiotherapyand abdominal physiotherapy
Scandinavian Conference in Cardiothoracic Surgery 2009
Members in the working groupMembers in the working group
Maria AntonssonBSc, Akademiska sjukhuset, UppsalaMonika Fagevik Olsén, Associate professor, Sahlgrenska Universitetssjukhuset, GöteborgHenrik JohanssonMSc, Akademiska sjukhuset, UppsalaLena SandströmMSc, Karolinska universitetssjukhuset, StockholmCharlotte Urell, PhD student, Akademiska sjukhuset, UppsalaElisabeth WesterdahlPhD, Universitetssjukhuset i ÖrebroMalin WiklundPhD student, Sahlgrenska Universitetssjukhuset, Göteborg
Scandinavian Conference in Cardiothoracic Surgery 2009
Why do we need national guidelines?
The aim of the guidelines is to gather the effects of respiratory physiotherapy treatments in thorax- and abdominal surgery and put it together with clinicalexperience.
Scandinavian Conference in Cardiothoracic Surgery 2009
How did we start?How did we start?
Respiratory physiotherapy treatments between 1980-2008
Written in english Extensive search in seven medical data
bases
Scandinavian Conference in Cardiothoracic Surgery 2009
Search wordsSearch words
• thoracic surgery• lung surgery• postoperative• chest physical therapy • breathing exercises• CPAP• Incentive spirometry• IPPB• positive expiratory pressure• pursed-lip breathing• resistance breathing
Scandinavian Conference in Cardiothoracic Surgery 2009
What studies did we choose?What studies did we choose?
• Randomized controlled studies
• Outcomes; secretion, hypoxia/hypercapnia,pulmonary volume, pneumonia,hospital time, ICD time, post pulmonarycomplications (atelectases, pneumonia), death.
Scandinavian Conference in Cardiothoracic Surgery 2009
The reviewThe review
34 cardiac- and 5 pulmonary studies were reviewed
1. Classifying on the basis of Verhagen (Delphi method)
2. Systematic selection
3. SBU
Scandinavian Conference in Cardiothoracic Surgery 2009
Verhagen scoringVerhagen scoring
• Questions about:
RandomizationBlindingSelection
Scandinavian Conference in Cardiothoracic Surgery 2009
The reviewThe review
34 cardiac- and 5 pulmonary studies were reviewed
1.Classifying on the basis of Verhagen (Delphi method)
2.Systematic selection
3.SBU
Scandinavian Conference in Cardiothoracic Surgery 2009
1. Specific respiratory treatment against anuntreated control group
2. Specific respiratory treatment included in ordinary treatment compared with onlyordinary treatment
3. One specific respiratory treatment against another specific respiratory treatment
Systematic selection
Scandinavian Conference in Cardiothoracic Surgery 2009
The reviewThe review
34 cardiac- and 5 pulmonary studies were reviewed
1.Classifying on the basis of Verhagen (Delphi method)
2.Systematic selection
3.SBU
Scandinavian Conference in Cardiothoracic Surgery 2009
ResultResult• 34 cardiac studies
Verhagen score(0-10)4 (> 7)30 (4-6)0 (0-3)Systematic selection7 (1)9 (2)19 (3)
• 5 pulmonary studies Verhagen score(0-10)
0 (>7)5 (4-6)0 (0-3)Systematic selection3 (1)2 (2)
Scandinavian Conference in Cardiothoracic Surgery 2009
What kind of treatments has been What kind of treatments has been studied?studied?
• Preoperative: fitness training, IS, IPPB, inspiratory muscle training
• Postoperative: DB, ACBT, IS, PEP, IR-PEP, CPAP, IPPB, Bilevel-PAP, huff, cough, early mobilization, manual techniques
Scandinavian Conference in Cardiothoracic Surgery 2009
Where did the studies come from?Where did the studies come from?
• Cardiac studies15 Europe6 Canada5 USA4 Brazil3 Australia1 Israel
• Pulmonary studies4 Europe1 Israel
Scandinavian Conference in Cardiothoracic Surgery 2009
National guidelinesNational guidelines
• Differences
• Discussions
• Evidence situation and clinical experiencenational guidelines
• Finished during 2009 (www.LSR.se)
Scandinavian Conference in Cardiothoracic Surgery 2009
Possibilities Possibilities
• Read a lot of articles
• Critical review
• Discuss with experieced collegues
• Run into ”new” treatments
• National network
• Create guidelines for colleagues
Scandinavian Conference in Cardiothoracic Surgery 2009
DifficultiesDifficulties
• Frustration
• Time
Scandinavian Conference in Cardiothoracic Surgery 2009
• What about clinical guidelines in the other Nordic countries?
• Have some of you worked with national guidelines?
Scandinavian Conference in Cardiothoracic Surgery 2009
DiscussionDiscussion
1. Do you have local guidelines at your hospital?
2. In what extent do you use guidelines in your clinical work?
3. What kind of things is important in a guideline document for the clinical physiotherapist?
4. How should we work with implementation of the guidelines?
Scandinavian Conference in Cardiothoracic Surgery 2009