[Unresolved issues in the prevention of bronchopulmonary complications in a cardiac surgery patient from the standpoint of a rehabilitation therapist]. / Nereshennye voprosy v profilaktike bronkholegochnykh oslozhnenii u kardiokhirurgicheskogo patsienta s pozitsii reabilitologa.

Bronchopulmonary complications are one of the leading causes of morbidity after cardiac surgery; they lengthen a patient's hospital stay and increase the cost of treatment. The most common postoperative bronchopulmonary complications include pneumonia, atelectasis, respiratory failure, pneumothorax, and bronchospasm. These complications are the consequences of anesthesia and surgical trauma aggravated by the presence of risk factors in the patient in the preoperative period such as any chronic disease involving the lungs, smoking history, persistent cough and / or wheezing, chest and spinal deformities, obesity, senior age. In addition, the presence of chronic heart failure, diabetes mellitus, and chronic kidney disease also increase the risk of developing bronchopulmonary complications. In the prevention and treatment of bronchopulmonary complications the clinical effectiveness of rehabilitation programs after coronary artery bypass grafting is undeniable. The effectiveness of the programs has been proven on the basis of both domestic and foreign long-term in-practice and scientific research. However, despite the significant advances in cardiac rehabilitation there are a number of unresolved issues. Is it possible in a short period of time of the first stationary rehabilitation stage to form the patient's skill to perform breathing exercises and, accordingly, to obtain the maximum effect in the prevention of bronchopulmonary complications? What factors can affect the speed of motor skill formation in the patient's mastering of breathing exercises? What should be the frequency of procedures per day and the number of exercises when a physical therapy instructor works with a patient to increase the effectiveness of the prevention of bronchopulmonary complications in the postoperative period? What category of patients is strictly required for the pre-rehabilitation stage? How should the pre-rehabilitation stage be organized and how long should it take? All these questions require the work-out and implementation of scientifically grounded individual rehabilitation programs with a step-by-step algorithm for managing the patient by a rehabilitation multi-team from the first hours after surgery with the mandatory inclusion of pre-rehabilitation and taking into account the social, anamnestic, clinical and psychological characteristics of the patient.

[The personalized approach to the rehabilitation of a severely ill patient presenting with a cardio-surgical problem]. / Personifitsirovannyi podkhod k reabilitatsii tiazhelogo patsienta kardiokhirurgicheskogo profilia.

The ever increasing number of the patients presenting with the cardio-surgical problems referred for surgery emphasizes the importance of the treatment of the cases of post-operative complications based on the personalized approach. The present article was designed to report a clinical case of the successful surgical treatment and rehabilitation of a patient presenting with the dysfunction of the bioprosthetic mitral valve and complications of the post-operative course in the form of polyorgan insufficiency with the predominance of respiratory failure. Special attention is given to the post-operative complications among which the respiratory insufficiency prevailed that made necessary the long period of artificial pulmonary ventilation. The specific features of the intense personalized approach to the physical rehabilitation of the given severely ill patient based at the intensive care unit are considered, the description of the methods applied for the purpose is presented, and their effectiveness from the perspective of clinical and functional parameters is evaluated. The study has demonstrated that the application of the intensive personalized approach in the given case turned out to be a safe and effective method of rehabilitation. The use of the proposed approach allowed to shorten the duration of the post-operative rehabilitation period, facilitated the patient's transfer to autonomous breathing and expansion of the motor activity under conditions of the intensive care unit. In addition, the use of the continuity principle and continuation of rehabilitation measures based at the cardiac surgery department provided the opportunity for the further expansion of the motor activity.

[Cognitive dysfunction after coronary artery bypass grafting]. / Kognitivnaia disfunktsiia posle koronarnogo shuntirovaniia.

Despite the advances in surgical and anesthetic techniques for coronary artery bypass grafting (CABG), the incidence of neurological complications, including postoperative cognitive dysfunction (POCD), remains high. CABG is performed more often in elderly patients with severe comorbidities. However, comprehensive prevention measures and POCD rehabilitation have not yet been developed. Physical training is an effective and safe method for correcting endothelial dysfunction, severe systemic inflammatory response syndrome, lipid peroxidation, i.e. mechanisms contributing to the development and severity of POCD.