Discussion
non-small cell lung cancer, postoperative pain, diaphragmatic dysfunction, pulmonary complications, pain, cough, lung cancer, chronic obstructive respiratory disease, atelectasia, COPD
NON-SMALL CELL LUNG CANCER, POSTOPERATIVE COMPLICATIONS, POSTOPERATIVE COMPLICATION, THORACIC, PULMONARY COMPLICATIONS, POSTOPERATIVE COMPLICATION, LUNG CANCER, ADVERSE EFFECTS, COLLAPSE, COPD
Thoracic surgery contains patient groups requiring close follow-up and treatment after surgery, due to the respiratory functions adversely affected from incisions and operation types carried out. Besides adverse effects of pulmonary resection performed, high concentrated oxygen intake, single-lung ventilation, patient staying in the same position and being immobile throughout surgery, diaphragmatic dysfunction cause respiratory functions to severely decrease and air way collapse. Anesthetic agents disrupt mucociliary activity and this results in decrease of mucus transport avoiding secretion drainage through the bronchioles while triggering pulmonary complications such as atelectasia. Also, thoracotomy causes serious postoperative pain and avoids secretion drainage by disabling patients to cough effectively and by obstructing deep breathing Rate of pulmonary complications occurring during changes in respiration after pneumotomy considerably increases. And It has been established that these pulmonary complications increase the length of hospital stay, hospital expenses as well as morbidity and mortality rates Based on this, 30 patients in the study group underwent pulmonary rehabilitation 3 hours a day throughout 7 days during the preoperative period. The program included breathing exercises, coughing technique exercise, incentive spirometry and BİPAP. While in some studies, PR was applied intensively for 1 week, in other studies it was applied for 4-6 weeks. And in our study, it was applied intensively for 1 week. In literature, it has been recorded that a 4–6-week PR would be difficult due to patient's unwillingness and since it delays the operation The study group consisting of 10 patients underwent intensive physiotherapy during preoperative period. In the study made by Pehlivan et al on 60 patients with non-small cell lung cancer where they investigated the effects of short-term intensive physiotherapy on pulmonary functions, intensive physiotherapy was performed on the patients in the study group consisting of 30 patients Postoperative complication rates and length of hospital stay were compared in two randomized studies carried out by Benzo et al. on patients who underwent lung cancer resection and who had a mid level, heavy COBD history. In the first study, a comparison was made between a 4-week preoperative conventional PR program and a standard maintenance therapy In the randomized controlled study analysing effect of high intensity preoperative pulmonary rehabilitation treatment on old aged patients carried out by Licker et al, an intensive pulmonary rehabilitation was performed on the patients in study group (n=74) while the control group (n=77) underwent standard maintenance therapySaito et al. investigated the effect of preoperative pulmonary rehabilitation on postoperative complication incidence in patients with chronic obstructive respiratory disease (COPD) In a study made by Sekine et al on COBD patients suffering from lung cancer who had undergone lobectomy, a two-week intensive physiotherapy was performed on the study group which continued throughout postoperative period We believe that segmental breathing exercises, diaphragmatic breathing exercises, puckered lip breathing, incentive spirometer and BIPAP application within the scope of intensive pulmonary rehabilitation program heal pulmonary functions and reserves, increase exercise tolerance, decrease postoperative complication incidence and reduce the length of hospital stay. Additionally, we believe along with the training provided in the postoperative period, pain tolerance and adaptation to the rehabilitation process increase.In the study made by Skinner EH on aged patients with lung cancer who have undergone surgery, effects of a 7-day preoperative pulmonary rehabilitation on pulmonary functions and length of hospital stay have been assessed. Aerobic endurance exercise, breathing exercises were applied for the study group (n=30) and a standard maintenance therapy was applied for the control group (n=30). At the end of the study, frequency of the postoperative complications was found to be lower and length of hospital stay was established to be shorter in the study group (average 3,8 days). In our study, a 7-day intensive rehabilitation was applied however, incentive spinometer and BIPAP application were performed instead of aerobic endurance exercises. As a result of the assessments, a significant decrease was recorded in the postoperative complication incidence rate and length of hospital stay.In the literature reviews, there are studies indicating that preoperative pulmonary rehabilitation applications have a positive effect on pulmonary mechanisms 