Patient Profile: Pulmonary
Browse resources on patients with pulmonary conditions that are commonly observed in the acute inpatient rehab setting.
Please click on a topic or see what catches your interest down below.
Treatments
Thoracostomy/Chest Tube
​
Pulmonary Collection
Conditions
From the authors: "Cancer-related fatigue (CRF) is common in lung cancer survivors and can occur at any point in the care continuum. CRF encompasses physical, emotional, and/or cognitive tiredness; is related to cancer or cancer treatments; and interferes with multiple dimensions of health-related quality of life...often presents with a cluster of symptoms, including pain, mood disorders, and sleep disturbance."
​
+ Bade BC, Faiz SA, Ha DM, et al. Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med. 2023;207(5):e6-e28. doi:10.1164/rccm.202210-1963ST
​
From the authors: "A pneumothorax is an accumulation of gas in the pleural space (the space between the visceral and parietal pleura of the chest cavity), which can impair ventilation, oxygenation, or both. This condition can vary in its presentation from asymptomatic to life-threatening."
​
+ Sajadi-Ernazarova KR, Martin J, Gupta N. Acute Pneumothorax Evaluation and Treatment. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538316/
​
From the authors: "Chronic obstructive pulmonary disease (COPD) is a common and treatable disease characterized by progressive airflow limitation and tissue destruction. It is associated with structural lung changes due to chronic inflammation from prolonged exposure to noxious particles or gases most commonly cigarette smoke. Chronic inflammation causes airway narrowing and decreased lung recoil. The disease often presents with symptoms of cough, dyspnea, and sputum production."
​
+ Agarwal AK, Raja A, Brown BD. Chronic Obstructive Pulmonary Disease. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559281/
​
From the authors: "More than 50 causes of pleural effusions are recognised,2 spanning a wide variety of medical specialties. The cause is often classified initially as either a transudative or an exudative process, with the former usually associated with cardiac, renal, or hepatic dysfunction and the latter with conditions that cause an excess of inflammation, such as malignancy or infection. The most common cause of a transudate, and probably effusions as a whole, is heart failure."
​
+ Bhatnagar R, Maskell N. The modern diagnosis and management of pleural effusions. BMJ. 2015;351:h4520. Published 2015 Sep 8. doi:10.1136/bmj.h4520
​
From the authors: "Pulmonary edema can be defined as an abnormal accumulation of extravascular fluid in the lung parenchyma. This process leads to diminished gas exchange at the alveolar level, progressing to potentially causing respiratory failure. Its etiology is either due to a cardiogenic process with the inability to remove sufficient blood away from the pulmonary circulation or non-cardiogenic precipitated by injury to the lung parenchyma."
​
+ Malek R, Soufi S. Pulmonary Edema. [Updated 2023 Apr 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557611/
​
From the authors: "Pneumonia has been defined as an infection of the lung parenchyma. Rather than looking at it as a single disease, health care professionals must remember that pneumonia is an umbrella term for a group of syndromes caused by a variety of organisms resulting in varied manifestations and sequelae."
​
+ Jain V, Vashisht R, Yilmaz G, et al. Pneumonia Pathology. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526116/
​
From the author: "Diagnosis of COVID-19 requires detection of SARS-CoV-2 RNA using a combination of nasopharynx and throat sample;4,5 SARS-CoV-2 RNA can also be detected in stool and blood.4 Chest computed tomography images from patients with COVID-19 typically demonstrate bilateral, peripheral ground glass opacities."
​
+ Karin M Felten-Barentsz, Roel van Oorsouw, Emily Klooster, Niek Koenders, Femke Driehuis, Erik H J Hulzebos, Marike van der Schaaf, Thomas J Hoogeboom, Philip J van der Wees, Recommendations for Hospital-Based Physical Therapists Managing Patients With COVID-19, Physical Therapy, Volume 100, Issue 9, September 2020, Pages 1444–1457, https://doi.org/10.1093/ptj/pzaa114
Treatments
From the authors: "The short-term effects of utilizing supplemental oxygen include an improvement in breathlessness in an individual with a decreased PaO2 and SpO2 at rest as well as a decreased breathlessness in individuals who demonstrate a decrease in SpO2 with exercise.15,16 Shortterm use of supplemental oxygen during exercise improves exercise tolerance in those with mild, moderate, or even severe hypoxemia during exercise."
​
+ Hillegass, Ellen PT, EdD, CCS, FAACVPR, FAPTA; Fick, Ann PT, DPT, MS, CCS; Pawlik, Amy PT, DPT, CCS; Crouch, Rebecca PT, DPT, CCS, FAACVPR; Perme, Christiane PT, CCS; Chandrashekar, Rohini PT, DPT, CCS; McNamara, Susan Butler PT, MMSc, CCS; Cahalin, Lawrence P. PT, PhD, CCS. Supplemental Oxygen Utilization During Physical Therapy Interventions. Cardiopulmonary Physical Therapy Journal 25(2):p 38-49, June 2014.
​
Robotic- and Video-Assisted Thoracoscopic Lobectomy or Segmentectomy
From the author: "The present meta-analysis showed that there were no significant differences in operative time, any complications, tumor size, chest drain duration, R0 resection rate, lymph station, 5-year overall survival, and recurrence rate. However, compared with the VATS group, the RATS group had less blood loss, a lower conversion rate to open, a shorter length of hospital stay, more lymph node dissection, and better 5-year disease-free survival."
​
+ Zhang J, Feng Q, Huang Y, Ouyang L, Luo F. Updated Evaluation of Robotic- and Video-Assisted Thoracoscopic Lobectomy or Segmentectomy for Lung Cancer: A Systematic Review and Meta-Analysis. Front Oncol. 2022;12:853530. Published 2022 Apr 12. doi:10.3389/fonc.2022.853530
​
From the authors: "There is mounting evidence for the role of wedge resection in early-stage lung cancer treatment, especially for frail patients unfit for general anesthesia and anatomic resections with nodules, demonstrating a non-aggressive biological behavior."
​
+ Ambrogi V, Patirelis A, Tajè R. Non-intubated Thoracic Surgery: Wedge Resections for Peripheral Pulmonary Nodules. Front Surg. 2022;9:853643. Published 2022 Apr 7. doi:10.3389/fsurg.2022.853643
​
From the authors: "In this article, we review the risk factors and prevention of the most common complications of thoracentesis including pneumothorax, bleeding (chest wall hematoma and hemothorax), and re-expansion pulmonary edema."
​
+ Cantey EP, Walter JM, Corbridge T, Barsuk JH. Complications of thoracentesis: incidence, risk factors, and strategies for prevention. Curr Opin Pulm Med. 2016;22(4):378-385. doi:10.1097/MCP.0000000000000285
​
From the author: "A thoracotomy is an incision into the pleural space of the chest...to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine...in many thoracic surgeries including lobectomy or pneumonectomy for lung cancer and as such requires general anesthesia with endotracheal tube insertion and mechanical ventilation, rigid bronchoscope can be also used if necessary. Thoracotomies are thought to be one of the most difficult surgical incisions to deal with post-operatively, because they are extremely painful and the pain can prevent the patient from breathing effectively, leading to atelectasis or pneumonia."
+ Lazopoulos A, Barbetakis N, Lazaridis G, et al. Open thoracotomy for pneumothorax. J Thorac Dis. 2015;7(Suppl 1):S50-S55. doi:10.3978/j.issn.2072-1439.2015.01.52
​
From the authors: "Pleurodesis is a procedure performed to obliterate the pleural space to prevent recurrent pleural effusions, pneumothorax, or to treat a persistent pneumothorax. Pleurodesis is commonly accomplished by draining the pleural fluid or intrapleural air followed by either a mechanical procedure or instilling a chemical irritant into the pleural space, which causes intense inflammation and fibrosis subsequently leading to adhesions between the two pleural membranes."
​
+ Ali M, Surani S. Pleurodesis. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560685/
​
From the authors: "Tube thoracostomy is the most commonly performed surgical procedure in thoracic surgery. It is defined as insertion of a tube (chest tube) into the pleural cavity to drain air, blood, bile, pus, chyle or other fluids."
+ Kuhajda I, Zarogoulidis K, Kougioumtzi I, et al. Tube thoracostomy; chest tube implantation and follow up. J Thorac Dis. 2014;6(Suppl 4):S470-S479. doi:10.3978/j.issn.2072-1439.2014.09.23
Rehabilitation
Official American Thoracic Society Statement: Concepts & Advances in Pulmonary Rehabilitation
From the authors: "To qualify as PR, programs must include, at a minimum: a structured and supervised exercise program for patients with a variety of respiratory conditions, a patient education/behavioral program intended to foster health-enhancing behavior, patient assessment and outcomes measures, and provision of recommendations for home-based exercise and physical activity "
​
+ Rochester CL, Vogiatzis I, Holland AE, et al. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2015;192(11):1373-1386. doi:10.1164/rccm.201510-1966ST
​
Essentials of Physiotherapy after Thoracic Surgery: What Physiotherapists Need to Know
From the authors: "Early upright positioning and mobilization improve functional recovery and reduce the hospital stay...TENS and ice packs are very effective in relieving postoperative incision pain, which can reduce the additional need for analgesia. Wound support should be provided during deep breathing exercises, coughing, FET, and arm or trunk ROM exercises. Deep breathing exercises have been traditionally used for postoperative patients as prophylactic treatment against PPCs...Postural correction and education about postural awareness are important following thoracic surgery. Shoulder, scapula, trunk, and leg mobility exercises are main components of postoperative physiotherapy. A PEP device and heated humidification are useful adjuncts to postoperative airway clearance physiotherapy."
+ Ahmad AM. Essentials of Physiotherapy after Thoracic Surgery: What Physiotherapists Need to Know. A Narrative Review. Korean J Thorac Cardiovasc Surg. 2018;51(5):293-307. doi:10.5090/kjtcs.2018.51.5.293
​
Chest PT for Patients in the ICU
From the authors: "Chest physical therapy is used in the intensive care unit (ICU) to minimize pulmonary secretion retention, to maximize oxygenation, and to reexpand atelectatic lung segments...Postural drainage, percussion, vibration, breathing exercises, cough stimulation techniques, and airway suctioning are described in detail."
​
+ Nancy D Ciesla, Chest Physical Therapy for Patients in the Intensive Care Unit, Physical Therapy, Volume 76, Issue 6, 1 June 1996, Pages 609–625, https://doi.org/10.1093/ptj/76.6.609
​
Is Incentive Spirometry Beneficial for Patients?
From the author: "Failure to clear airway secretions remains to be a major concern for patients undergoing thoracic surgery. Although manual percussion with chest wall vibration is widely applied in respiratory physiotherapy, it is labor-intensive and time-consuming. Moreover, postoperative pain may interfere with performance of percussion. The purpose of incentive spirometer is for patients to take a sustained maximal inspiratory effort, which allows a large inflating volume and transpulmonary pressure gradient for several seconds to reach lung expansion. The use of IS assists the maintenance of airway patency at risk of closure and removes retained airway secretions. In addition, IS provides patients with visual feedback in terms of volume, with regard to inspiratory effort to reach a measurable goal and encourage adherence to therapy."
​
+ Liu, CJ., Tsai, WC., Chu, CC. et al. Is incentive spirometry beneficial for patients with lung cancer receiving video-assisted thoracic surgery?. BMC Pulm Med 19, 121 (2019). https://doi.org/10.1186/s12890-019-0885-8
​
Safe and Effective Prescription of Exercise in Acute Exacerbations of COPD
From the author: "Exercise is recommended for people with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), yet there is little information to guide safe and effective mobilization and exercise for these patients. The AECOPD-Mob provides practical and concise information on safe and effective exercise for the AECOPD population for use by the new graduate or novice acute care practitioner."
​
+ Pat G. Camp, W. Darlene Reid, Frank Chung, Ashley Kirkham, Dina Brooks, Donna Goodridge, Darcy D. Marciniuk, Alison M. Hoens, Clinical Decision-Making Tool for Safe and Effective Prescription of Exercise in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Results From an Interdisciplinary Delphi Survey and Focus Groups, Physical Therapy, Volume 95, Issue 10, 1 October 2015, Pages 1387–1396, https://doi.org/10.2522/ptj.20140542
​
Acute Care Rehab and 30-Day Hospital Readmission or Mortality in Adult Patients With Pneumonia
From the authors: "In this study, the amount of therapy received by patients with pneumonia or influenza-related conditions in the acute care setting was associated with decreases in the risk of 30-day hospital readmission or death."
​
+ Freburger JK, Chou A, Euloth T, Matcho B. Variation in Acute Care Rehabilitation and 30-Day Hospital Readmission or Mortality in Adult Patients With Pneumonia. JAMA Netw Open. 2020;3(9):e2012979. doi:10.1001/jamanetworkopen.2020.12979
​
Physiotherapy Management for COVID-19 in the Acute Hospital Setting and Beyond
From the authors: "The recommendations remain focused on adult patients in acute hospital settings and are structured around: physiotherapy workforce planning and preparation; delivery of physiotherapy interventions, including both respiratory and mobilisation/rehabilitation; and PPE requirements for physiotherapy service delivery. They have also been expanded to address the long-term impacts of COVID-19 and the implications they have for acute hospital physiotherapy services."
+ Thomas P, Baldwin C, Beach L, et al. Physiotherapy management for COVID-19 in the acute hospital setting and beyond: an update to clinical practice recommendations. J Physiother. 2022;68(1):8-25. doi:10.1016/j.jphys.2021.12.012
​
Supplemental Oxygen Utilization During Physical Therapy Interventions
From the authors: "To safely maximize and optimize the functional ability of the patient, the role of the physical therapist is to: (1) assist with titration of supplemental oxygen, (2) discuss in safety with activity, (3) present appropriate exercise prescriptions to increase functional performance, and (4) instruct patients in use of appropriate breathing exercises to optimize supplemental oxygen and decrease breathlessness."
​
+ Hillegass, Ellen PT, EdD, CCS, FAACVPR, FAPTA; Fick, Ann PT, DPT, MS, CCS; Pawlik, Amy PT, DPT, CCS; Crouch, Rebecca PT, DPT, CCS, FAACVPR; Perme, Christiane PT, CCS; Chandrashekar, Rohini PT, DPT, CCS; McNamara, Susan Butler PT, MMSc, CCS; Cahalin, Lawrence P. PT, PhD, CCS. Supplemental Oxygen Utilization During Physical Therapy Interventions. Cardiopulmonary Physical Therapy Journal 25(2):p 38-49, June 2014.