Oxygen Transport: A Physiologically-based Conceptual Framework for the Practice of Cardiopulmonary Physiotherapy

doi:10.1016/S0031-9406(10)61093-0

Physiotherapy

Volume 80, Issue 6, 10 June 1994, Pages 347-354

https://doi.org/10.1016/S0031-9406(10)61093-0 Get rights and content

Summary

In this era of quality assurance and cost effectiveness, physiotherapy management of cardiopulmonary conditions needs to be aligned with the physiologic and scientific literature, which current practice does not reflect. This article presents a conceptual framework for practice based on oxygen transport, and describes five factors that contribute to the lack of efficacy of conventional chest physiotherapy with special reference to manual chest percussion.

First, the theoretical conceptualisation of chest physiotherapy primarily based on secretion clearance and its purported clinical goal of improved ventilation is no longer tenable. This focus is too narrow in that it fails to address oxygen transport as a whole.

Second, sputum production is a highly questionable measure of treatment outcome. Its relationship with pulmonary function and gas exchange overall is inconsistent.

Third, the potent physiologic effects of body positioning and mobilisation/exercise can explain treatment effects that are frequently attributed to conventional chest physiotherapy.

Fourth, chest physiotherapy is associated with various adverse side effects.

Fifth, the literature supports the use of judicious as opposed to routine positioning and mobilisation/exercise as primary interventions to remediate acute as well as chronic cardiopulmonary dysfunction or minimise its threat.

If cardiopulmonary physiotherapy is to be an essential physiologically-based specialty in this area of accountability, practice must be aligned with the physiologic and scientific literature and continually updated with the integration of new knowledge.

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An exploration of the professional identity embedded within UK cardiorespiratory physiotherapy curricula
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However, this mirrors other authors’ concerns that physiotherapy retains a strong allegiance to the biomedical model within its epistemology [32,33]. Perhaps this emphasis arises from the only model of CPT to have been published: Dean's [34] conceptual model of cardiopulmonary practice based on the oxygen transport pathway. This created a paradigm shift in the way that physiotherapists conceptualised CPT.
To explore whether consensus exists about content and professional identity represented within pre-registration cardiorespiratory physiotherapy (CPT) curricula, and to establish whether the curricula feature contemporary themes evident in policy and professional guidance in order to test whether CPT education is demonstrating responsiveness and relevance to practice.
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Fourteen UK higher education institutions offering undergraduate physiotherapy qualifying programmes agreed to participate.
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The aim of this study was to investigate the effects of mobilisation on respiratory and haemodynamic variables in the intubated, ventilated abdominal surgical patient. Mobilisation was defined as the progression of activity from supine, to sitting over the edge of the bed, standing, walking on the spot for one minute, sitting out of bed initially, and sitting out of bed for 20 minutes. Seventeen patients with age (mean ± SD) 71.4 ± 7.1 years satisfied inclusion criteria. Respiratory and haemodynamic parameters were measured in each of the above positions and compared with supine. In the 15 subjects who completed the protocol, standing resulted in significant increases in minute ventilation (V_E) from 15.1 ± 3.1 l/min in supine to 21.3 ± 3.6 l/min in standing (p < 0.001). The increase in V_E in standing was achieved by significant increases in tidal volume (V_T) from 712.7 ± 172.8 ml to 883.4 ± 196.3 ml (p = 0.008) and in respiratory rate (ƒ_R) from 21.4 ± 5.0 breaths/min to 24.9 ± 4.5 breaths/min (p = 0.03). No further increases were observed in these parameters beyond standing when activity was progressed to walking on the spot for one minute. When supine values were compared with walking on the spot for one minute, inspiratory flow rates (V_T/T_I) increased significantly from 683 ± 131.8 ml/sec to 985.1 ± 162.3 ml/sec (p = 0.001) with significant increases in rib cage displacement (p = 0.001) and no significant increase in abdominal displacement (p = 0.23). Arterial blood gases displayed no improvements following mobilisation. Changes in V_T, ƒ_R, and V_E were largely due to positional changes when moving from supine to standing.

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Treatment ReportOxygen Transport: A Physiologically-based Conceptual Framework for the Practice of Cardiopulmonary Physiotherapy

Summary

Chest

Chest

Clinics in Chest Medicine

Chest

Lancet

Physiotherapy

Chest

Chest

Lancet

Chest

Chest

Chest

Chest

Chest

Clinics in Chest Medicine

Chest

‘Factors affecting regional distribution of ventilation and perfusion in the lung’

Journal of Applied Physiology

‘The effect of chest physiotherapy upon the FEV1 in chronic bronchitis’

Medical Journal of Australia

‘Effect of body position on gas exchange in patients with unilateral central airway lesions. Down with the good lung’

Chest

‘Effect of postoperative immobilisation after coronary artery by-pass surgery’

Critical Care Medicine

‘Effects of changing body position upon improved ventilation-perfusion relationships’

Circulation

‘Effects of sputum on pulmonary function’

British Medical Journal

‘Closing volume and its relationship to gas exchange in seated and supine positions’

Journal of Applied Physiology

‘Independently measured oxygen consumption does not depend on oxygen delivery in adult respiratory distress syndrome (ARDS)’

Clinical and Investigative Medicine

‘Cystic Fibrosis and Physical Activity’

International Journal of Sports Medicine

‘The effect of body position on pulmonary function’

Physical Therapy

‘Bedrest and deconditioning’

Neurology Report

‘Physiotherapy skills: Positioning and mobilisation of the patient’

Commentary on ‘Are incentive spirometry, intermittent positive pressure breathing and deep breathing exercises effective in the prevention of post-operative pulmonary complications following upper abdominal surgery’

Physical Therapy

‘Integrating current literature in the management of cystic fibrosis: A rejoinder’

Physiotherapy Canada

‘Mobilisation and body conditioning’

‘Cough versus chest physiotherapy’

American Review of Respiratory Disease

‘Improved oxygenation in patients with extensive unilateral pneumonia using the lateral decubitus position’

Thorax

Cash's Textbook of Chest, Heart and Vascular Disorders for Physiotherapists

‘Nursing care of surgical patients: I. The “stir-up”,’

American Journal of Nursing

‘Are maximal inspiratory breathing exercises or incentive spirometry better than early mobilisation after cardiopulmonary by-pass?’

Physical Therapy

‘Effect of physical training on oxygen transport system in man’

Acta Physiologica Scandinavica

Chest Physical Therapy and Pulmonary Rehabilitation

‘Effects of physiotherapy during intermittent positive pressure breathing: changes in arterial blood gas tensions’

Anaesthesia

Treatment Report
Oxygen Transport: A Physiologically-based Conceptual Framework for the Practice of Cardiopulmonary Physiotherapy

‘The effect of chest physiotherapy upon the FEV₁ in chronic bronchitis’