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Programmed Post-Operative Physiotherapy May Improve Functional Outcomes in Pneumonectomy Patients of Rare Causes ��? Case Series

Manivel A, Baskaran C, Murugesan PR

Physical therapy management for pneumonectomy has been long addressed in earlier literature. Post-operative pneumonectomy physiotherapy routinely administered in post-operative wards includes chest physiotherapy, positioning for ventilator perfusion (V/Q) matching, early in-bed and out of bed activities, early graded ambulation and ADL (activity of daily living) training. Though contrary results exist proving the post-operative pneumonectomy physiotherapy’s effectiveness, routine post-operative physiotherapy regime is carried out in almost all the post pneumonectomy patients. Post-pneumonectomy in-patient protocols vary with different institutions and hospitals across globe. This makes the study results generalization difficult and hence the negativeness in reviews analyzing the pooled results. But still in pneumonectomy, critical thinking and expertise therapeutic application still can give better results in post-operative pneumonectomy patients. We present two pneumonectomy patients of unique causes whose outcomes encourage us to make a case series and may benefit the cardiopulmonary physical therapist in their clinical and practical appliances. A variety of modalities for pain, exercise techniques and early mobility are evidence-based and must be implemented depending on each postoperative day according to co-morbid conditions and cooperation of the patients. The physiotherapist should be responsible for implementing mobilization plans, exercise prescription and education to make recommendations in progression of patient’s outcomes. Protocol based post-operative physical therapy regime is effective in improving pneumonectomy patients of rare causes. These pneumonectomy cases recovered better and lesser hospital stay with protocol based post-operative physiotherapeutic management. We expect similar improvement in all post-operative pneumonectomy cases of any causes. This may be addressed through large randomized controlled trials comparing our protocols with others in near future.