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Lecturer(s)
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Gaul Aláčová Petra, Mgr. Ph.D.
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Zbořilová Lada, Mgr.
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Dus Marta, Mgr.
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Course content
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1. Classification of cardiothoracic surgical procedures and postoperative hemodynamics -Classification of cardiac and major thoracic surgical procedures from the physiotherapy perspective. Surgical approach (sternotomy vs thoracotomy) and use of cardiopulmonary bypass as determinants of postoperative respiratory and hemodynamic burden. Pathophysiology including low cardiac output syndrome, vasoplegia, arrhythmias, bleeding and fluid shifts. Risk stratification for early physiotherapy intervention. 2. Respiratory physiology, weaning and sternotomy Load Management -Breathing mechanics after sternotomy and cardiopulmonary bypass. Ventilation-perfusion mismatch, atelectasis and pulmonary edema in the early postoperative phase. Principles of ventilator weaning, spontaneous breathing trials and predictors of weaning success. Weaning-induced cardiac dysfunction and its pathophysiological background. Contemporary evidence on sternal stability and rational upper limb load management. 3. Advanced monitoring, mechanical ventilation and ECMO in cardiac ICU -Invasive and non-invasive mechanical ventilation, patient-ventilator interaction and physiotherapist's role in the weaning process. Interpretation of key hemodynamic and respiratory parameters for clinical decision-making. Chest drains, temporary pacing wires and vascular lines in practice. Fundamentals of veno-venous and veno-arterial ECMO and criteria for safe physiotherapy and mobilisation. 4. Comprehensive assessment, functional evaluation and clinical reasoning in the weaning phase -Integrated respiratory, cardiovascular and functional assessment during mechanical ventilation and the weaning period. Recognition of signs of respiratory muscle fatigue, diaphragm dysfunction and cardiovascular intolerance to spontaneous breathing. Screening for pain, fatigue and delirium. Use of selected ICU outcome measures. Clinical reasoning, prioritisation and SMART goal setting in patients transitioning from ventilatory support. 5. Practical skills I: Respiratory physiotherapy and support during weaning -Hands-on practice of lung expansion strategies, inspiratory muscle facilitation and airway clearance in post-cardiac surgery patients. Positioning to optimise oxygenation and cardiac performance during spontaneous breathing trials. Practical approaches to supporting respiratory muscles and preventing extubation failure. 6. Practical skills II: Early mobilisation in patients with vasoactive support, during and after Weaning -Stepwise progression from bed mobility to ambulation in cardiothoracic ICU. Dosing and monitoring of mobilisation in patients with arrhythmias, low cardiac output and vasoactive medication. Mobilisation during the weaning phase and early post-extubation period. Principles of mobilisation in patients on ECMO support while maintaining sternal integrity and hemodynamic stability. 7. Case study presentation - PechaKucha format -Structured PechaKucha presentation of a cardiothoracic ICU patient, including surgical background, ventilatory course, weaning process, hemodynamic profile, assessment findings, goal setting, intervention and outcomes. Emphasis on clinical reasoning, identification of risk during weaning and justification of therapeutic decisions. 8. Final test and practical oral examination -Written test assessing understanding of cardiothoracic postoperative pathophysiology, monitoring interpretation, ventilator weaning and physiotherapy management. Practical oral examination focused on clinical reasoning and safe decision-making in cardiothoracic ICU scenarios.
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Learning activities and teaching methods
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unspecified
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Learning outcomes
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The aim of the course is to develop advanced competencies in physiotherapy management of patients in cardiothoracic intensive care. After completing the course, the student will be able to: -understand the role of a physiotherapist in cardiothoracic intensive care, including safety principles and interdisciplinary cooperation -explain postoperative cardiopulmonary changes after cardiothoracic surgery relevant to physiotherapy -safely apply physiotherapy interventions in patients with ICU devices and monitoring -use selected questionnaires and outcome measures for assessment and SMART goal setting in intensive care -perform respiratory and functional assessment of cardiothoracic ICU patients -apply evidence-based pulmonary physiotherapy and integrate respiratory and functional interventions, -demonstrate clinical reasoning through case study analysis and presentation
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Prerequisites
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unspecified
KFA/PTB22 and FYT/PTA32 and KFA/PTA31 and KFA/PTA32 and KFA/PTA34 and KFA/PTB32 and FYT/PTA42
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Assessment methods and criteria
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unspecified
Attendance and Participation in Class: The student is required to attend all lectures, seminars and clinical sessions (100% attendance) and actively participate in all class activities. Active participation includes engagement in discussions, practical tasks and seminars. Credit Requirements: During the semester, the student may be asked short oral questions or assigned brief tasks to demonstrate knowledge of previously covered topics. Each student is required to prepare and present one selected questionnaire or outcome measure relevant to intensive care physiotherapy. At the end of the semester, the student must prepare and present a case study of one patient from cardiothoracic intensive care practice. The case study presentation will be delivered in the Pecha Kucha format. At the end of the semester, the student will take a written multiple-choice theory test covering the course material. A minimum score of 70% is required to pass.
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Recommended literature
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Gibbon, G. J., Geddes, D. M., Costabel, U., Sterk, P. J., Corrin, B. (2003). Respiratory Medicine. Saunders.
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HARDEN, B., CROSS, J., & BROAD, M. A. Respiratory physiotherapy: An on-call survival guide. Elsevier Health Sciences.
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HOUGH, A. (2014). Physiotherapy in respiratory and cardiac care: an evidence-based approach. Andover.
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CHAITOW, L., BRADLEY, D., GILBERT, CH. (2002). Multidisciplinary approaches to breathing pattern disorders. Edinburg.
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MALIK M., CAMM J. A. (1995). Heart Rate Variability.
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MCCONNELL, A. (2013). Respiratory muscle training: theory and practice. S.l.
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Parrillo, J., E., Dellinger, R. (2008). Critical care medicine: principles of diagnosis and management in the adult. Philadelphia, PA.
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Pryor, J. A. (2002). Physiotherapy for respiratory and cardiac problems: Adults and paediatrics. Edinburgh.
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