Coronary Artery Bypass Grafting

[kinny75]

Hi, I wonder if anyone can help me. A patient had a coronary artery bypass grafting 6 days ago (following MI 6 months ago). What physiotherapy problems would be have prior to discharge and what type of advice/exercise programme would he be sent home with?

Any advice/articles etc would be really helpful!

Thanks

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[Canadian_PT]

Every treatment you provide needs to be very patient-specific because every patient is unique!
There are a multitude of PT problems the patient could have depending on the outcomes of the surgery, any complications, and baseline status. You need to look at two major areas
1. Chest status - the cardioresp part
2. Mobility - the MSK part.

1. Is the patient's chest stable enough to return home? Is he on room air or supplemental O2? Is his O2 saturation stable (generally over 90% but depends on baseline) at rest and with activity? Is he retaining or clearing secretions?

2. Is the patient mobilizing safely and independently? If not - what are you going to do about it? Are you going to give him a mobility aid? Send him for further rehabilitation? Keep him longer to allow him to strengthen further?

These are just some of the things to get you thinking about potential patient discharge. Everyone is unique. Make sure you look at chest and mobility before you make any final decisions.

[HighRevinDPT]

I am uncertain of the surgical precautions enforced in your respective countries, but in the US we must be tailor our interventions to Sternal Precautions that markedly alter the manner in which we teach transfers, bed mobility, and therapeutic exercise. O2 Sat is also highly valuable in monitoring improvements in cardiorespiratory endurance and as well as acute responses to exercises. Often our issues with insurance force discharge before Sternal Precautions are lifted and often require the recommendation of continued home PT/enrollment in cardiac rehab/hiring of home health aides until the physician deems the sternal incision is appropriately healed for UE use.
Areas of focus are obviously ambulatory with appropriate AD (both indoors/outdoors) on variable surfaces with ramps, curbs, etc. Stair training, Car transfers, bathroom transfers, and dynamic balance activities while concurrently monitoring 02 Sat responses. Education is of course pivotal as well (i.e. bracing incision if coughing/sneezing). I'd be interested in knowing if other countries utilize similar precautions s/p CABG as the US?

[Gupta1984]

hello
HighRevinDPT

Ya all the neccessary precautions are taken in INDIA too for the cardiac surgeries including CABG..

Main concern area are their mobilization, all necessary precautions to be taken, LE and UE training acc to functional capacity of the patient ...

I would be happy if you share some other necessary step you people used to take in post cardiac surgery patients...