The effect of selective drainage positions on oxygen saturation in obese patients after upper abdominal surgery.

The obese patients undergoing upper abdominal surgery are at particularly high risk to develop postoperative pulmonary complications, and hypoxemia is one of the most common ones reported. During the initial postoperative period, they are often advised to maintain a semi-sitting position to optimize oxygenation. Although chest physical therapy usually avoids a Trendelenburg position, no published data indicate this position as being able to induce desaturation in obese patients following upper abdominal surgery. We studied fifteen adult obese patients without cardiopulmonary disease undergoing upper abdominal surgery. All patients were tested for 5 minutes during the first 3 postoperative days in each of 3 positions: semi-sitting, bed-flat lateral decubitus, and 15 degrees of Trendelenburg lateral decubitus positions. A statistically significant difference in oxygen saturation related to position was found only on the first postoperative day between semi-sitting and bed-flat lateral decubitus positions. The difference in mean SaO2 value between these 2 positions, however, was only 0.88%; and no significant correlation between the magnitude of obesity and the mean SaO2 difference was found. Although arterial oxygen saturation demonstrated statistically significant daily improvement during the first 3 postoperative days, the mean SaO2 values for any 2 consecutive days differed by less than 0.78%. Thus, in obese patients following upper abdominal surgery, 15 degrees of Trendelenburg lateral decubitus and bed-flat lateral decubitus positions do not induce clinically significant desaturation and can be used if necessary and appropriate. In obese patients with borderline oxygenation, supplemental oxygen used postoperatively can maintain adequate oxygenation and allow aggressive positioning.

Pathokinesiology--the clinical implications from a cardiopulmonary perspective.

Do we really need our own area of science or do we just want it? Do we have it, can we find it or create it, or are we just renaming areas of existing science and study and applying them to our framework? Are we prepared to modify our existing educational structure to reflect clearly this area of science: kinesiology-pathokinesiology from the cellular level to the person level to include all relevant systems? If we adopt the science of pathokinesiology as the basis for physical therapy, will that direct the physical therapists who execute and publish research studies evaluating the effects of positioning, postural drainage, or phase one cardiac rehabilitation programs to study patient populations rather than college student groups? We cardiopulmonary therapists can fit within this pathokinesiological framework if the profession is able to answer many of the questions raised in this discussion. Those answers should illuminate the best fit for the patient without discernable movement dysfunction after coronary bypass graft surgery or the patient with an abcessed right middle lobe of the lungs who has no increase in chest wall mobility after treatment but does demonstrate a decrease in temperature and improved chest roentgenogram findings. The overriding question that I have as a clinician is, does the term pathokinesiology help our professionalism or simply create a new and different framework within which we need to explain physical therapy once more to ourselves, the medical community, our patients, our reimbursers, and the public at large?

Physical therapy for the acutely ill medical patient.

Chest physical therapy for acutely ill medical patients is a specialty that has evolved in response to patient need and medical progress. With the ability to support the patient's respiratory system mechanically came the requirement to manage acute and chronic lung injuries and their complications. Techniques of evaluation and treatment are discussed. A literature review focusing on treatment techniques for acutely ill patients and the efficacy of these treatments is included.