Omirilik Yaralanmalarında Pulmoner Rehabilitasyon
Özet
Omurilik yaralanmaları (OY), motor, duyusal ve otonomik işlevleri bozarak bireyin fiziksel ve psikolojik sağlığını derinden etkileyen yıkıcı durumlardır. Günümüzde solunum kaynaklı komplikasyonlar (pnömoni, atelektazi), özellikle tetraplejik hastalar arasında OY sonrası ilk yıl ve sonrasında önde gelen ölüm nedenlerinden biri haline gelmiştir. Pulmoner rehabilitasyon (PR); hasta değerlendirmesini, egzersiz eğitimini ve göğüs fizyoterapisini içeren, solunum semptomlarını azaltmayı ve hastanın yaşam kalitesini optimize etmeyi amaçlayan kapsamlı ve multidisipliner bir yaklaşımdır. OY düzeyine bağlı olarak ortaya çıkan ventilasyon bozukluklarının yönetiminde diyafram eğitimi, yardımcı öksürme teknikleri ve sekresyonların temizlenmesi kritik önem taşır. PR programları hastanede yatarak, ayaktan veya evde uygulanabilmekte, son dönemde internet tabanlı telerehabilitasyon modelleri de geleneksel yöntemlere eşdeğer sonuçlar sunarak erişilebilirliği artırmaktadır. OY'li hastalarda yaşam boyu interdisipliner takip ve PR uygulamaları, morbiditeyi azaltmada ve sağ kalımı iyileştirmede temel unsurdur.
Spinal cord injuries (SCI) are devastating conditions that profoundly impact an individual's physical and psychological well-being by impairing motor, sensory, and autonomic functions. Currently, respiratory complications such as pneumonia and atelectasis have become a leading cause of death during and after the first year following SCI, particularly within the tetraplegic population. Pulmonary rehabilitation (PR) is a comprehensive, multidisciplinary approach consisting of patient assessment, exercise training, and chest physiotherapy, aimed at reducing respiratory symptoms and optimizing the patient's quality of life. In managing restrictive ventilation disorders caused by the level of SCI, diaphragmatic training, assisted coughing techniques, and secretion clearance play a critical role. PR programs can be delivered through inpatient, outpatient, or home-based models, while recently emerging internet-based telerehabilitation options provide equivalent clinical outcomes and enhance accessibility. Lifelong interdisciplinary follow-up and targeted PR interventions are fundamental components to reduce secondary morbidity and improve survival rates in patients with SCI.
Referanslar
Nas K, Yazmalar L, Şah V, et al. Rehabilitation of spinal cord injuries. World J Orthop. 2015 Jan 18;6(1):8-16. doi: 10.5312/wjo.v6.i1.8. PMID: 25621206; PMCID: PMC4303793.
Eli I, Lerner DP, Ghogawala Z. Acute Traumatic Spinal Cord Injury. Neurol Clin. 2021 May;39(2):471-488. doi: 10.1016/j.ncl.2021.02.004. Epub 2021 Mar 31. PMID: 33896529.
Yip PK, Malaspina A. Spinal cord trauma and the molecular point of no return. Mol Neurodegener 2012; 7: 6 [PMID: 22315999 DOI: 10.1186/1750-1326-7-6]
Mahan ST, Mooney DP, Karlin LI, et al. Multiple level injuries in pediatric spinal trauma. J Trauma 2009; 67: 537-542 [PMID: 19741397 DOI: 10.1097/TA.0b013e3181ad8fc9]
Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World J Orthop. 2015 Jan 18;6(1):24-33. doi: 10.5312/wjo.v6.i1.24. PMID: 25621208; PMCID: PMC4303787.
Perrouin-Verbe B, Lefevre C, Kieny P, et al. Spinal cord injury: A multisystem physiological impairment/dysfunction. Rev Neurol (Paris). 2021 May;177(5):594-605. doi: 10.1016/j.neurol.2021.02.385. Epub 2021 Apr 27. PMID: 33931244.
National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance.. Birmingham, AL: University of Alabama at Birmingham; 2020.
Savic G, DeVivo MJ, Frankel HL, et al. Causes of death after traumatic spinal cord injury — a 70-year British study. Spinal Cord 2017;55:891–7. http://dx.doi.org/10.1038/sc.2017.64.
Gülbaş G. Pulmoner Rehabilitasyon Giriş ve Tanımlama. Gazi Gülbaş (Ed.), Pulmoner Rehabilitasyon (s 1-4). https://www.solunum.org.tr/TusadData/Book /853/1412021103249-1072020171337
Hodgkin JE, Farrell MJ, Gibson SR, et al. American Thoracic Society. Position statement of pulmonary rehabilitation. Am Rev Respir Dis 1981;124:663-6
Troosters T, Blondeel A, Janssens W, et al. The past, present and future of pulmonary rehabilitation. Respirology. 2019 Sep;24(9):830-837. doi: 10.1111/resp.13517. Epub 2019 Mar 13. PMID: 30868699.
Celli B, Goldstein R. A historical perspective of pulmonary rehabilitation. In: Clini E , Holland AE , Pitta F et al. (eds) Textbook of Pulmonary Rehabilitation. Cham, Springer Imprint, 2018; 3–18.
Nici L, Donner C, Wouters E, et al. American Thoracic Society/ European Respiratory Society statment on pulmonary rehabilitation. Am J Respir Crit Care Med, 2006; 173: 1390-413.
Spruit MA, Singh SJ, Garvey C, et al;on behalf of the ATS/ ERS Task Force on Pulmonary Rehabilitation. An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation. Am J Respir Crit Care Med 2013;188:13-64.
Celli BR, ZuWallack RL. Pulmonary Rehabilitation. In: Mason RJ, Broaddus VC, Martin TR, King Jr TE, Schraufnagel DE, Murray JF, Nadel JA, editors. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. PAHiladelPAHia. Saunders; 2010.p.2180-93.
Corhay JL, Dang DN, Cauwenberge HV, et al. Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapy. International Journal of COPD 2014:9 27–39.
Tsutsui M, Gerayeli F, Sin DD. Pulmonary Rehabilitation in a Post-COVID-19 World: Telerehabilitation as a New Standard in Patients with COPD. Int J Chron Obstruct Pulmon Dis. 2021 Feb 19;16:379-391. doi: 10.2147/COPD.S263031. PMID: 33642858; PMCID: PMC7903963.
Vogiatzis I, Rochester CL, Spruit MA, et al; American Thoracic Society/European Respiratory Society Task Force on Policy in Pulmonary R. Increasing implementation and delivery of pulmonary rehabilitation: key messages from the new ATS/ERS policy statement. Eur Respir J. 2016;47(5):1336–1341. doi:10.1183/13993003.02151-2015.
Chen W, Thomas J, Sadatsafavi JM, et al. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(8):631–639. doi:10.1016/S2213-2600(15)00241-6.
Ergün P. Pulmoner Rehabilitasyon Güncel Yaklaşımlar. Mehmet Karadağ (Ed.), Pulmoner Rehabilitasyon (s 7-18) Güncel Göğüs Hastalıkları Serisi 2019; 7 (1).
ATS/ERS Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med 2013;188:13–64.
Aydın Güçlü Ö, Görek Dilektaşlı A. Pulmoner Rehabilitasyon Program Organizasyonu. Gazi Gülbaş (Ed.), Pulmoner Rehabilitasyon (s 9-13) https://www.solunum.org.tr/TusadData/Book /853/1412021103249-1072020171337
Hill NS. Pulmonary rehabilitation. Proceedings of the American Thoracic Society 2006; 3: 66- 74.
Rochester CL. Patient assessment and selection for pulmonary rehabilitation. Respirology. 2019 Sep;24(9):844-853. doi: 10.1111/resp.13616. Epub 2019 Jun 28. PMID: 31251443.
Franssen FME, Rochester CL. Comorbidities in patients with COPD and pulmonary rehabilitation: do they matter? Eur. Respir. Rev. 2014; 23: 131–41.
Leitl D, Jarosch I, Glöckl R, et al. Rehabilitation in der Pneumologie [Rehabilitation in pneumology]. Pneumologe (Berl). 2021 May 7:1-10. German. doi: 10.1007/s10405-021-00395-0. Epub ahead of print. PMID: 33976600; PMCID: PMC8103139.
Spruit MA, Holland AE, Singh SJ, et al. COVID-19: Interim Guidance on Rehabilitation in the Hospital and Post-Hospital Phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force. Eur Respir J. 2020 Aug 13;56(6):2002197. doi: 10.1183/13993003.02197-2020. Epub ahead of print. PMID: 32817258; PMCID: PMC7427118.
Köseoğlu B.F. (2016). Pulmoner Rehabilitasyon. Mehmet Beyazova, Yeşim Gökçe Kutsal (Ed) Fiziksel Tıp ve Rehabilitasyon içinde (s 1271-1284). Ankara: Güneş Tıp Kitapevi.
Niksarlıoğlu E.Y. Pulmoner Rehabilitasyon Endikasyonları. Gazi Gülbaş (Ed.), Pulmoner Rehabilitasyon içinde (s 5-8). https://www.solunum.org.tr/TusadData/Book /853/1412021103249-1072020171337.
Solak Ö, Kavuncu V. (2015). Pulmoner Rehabilitasyon. Hasan Oğuz (Ed). Tıbbi Reahabilitasyon içinde ( s 1025-1042). İstanbul: Nobel Tıp Kitapevi.
Chilero GJ, Bauman WA, Radulovic M. Traumatic spinal cord injury: pulmonary physiologic principles and management. Clin Chest Med 2018;39(2):411–25. http:// dx.doi.org/10.1016/ j.ccm.2018.02.002.
Roquilly A, Vigué B, Boutonnet M, et al. French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury. Anaesth Crit Care Pain Med 2020;39(2):279–89. http://dx.doi.org/10.1016/ j.accpm.2020.02.003.
Le Pimpec-Barthes F, Legras A, Arame A, et al. Diaphragm pacing: the state of r e v u e n e u r o l o g i q u e 1 7 7 ( 2 0 2 1 ) 5 9 4 – 6 0 5 603 the art. J Thorac Dis 2016;8(Suppl 4):S376–86. http:// dx.doi.org/10.21037/jtd.2016.03.97.
Posluszny Jr JA, Onders R, Kerwin AJ, et al. Multicenter review of diaphragm pacing in spinal cord injury: successful not only in weaning from ventilators but also in bridging to independent respiration. J Trauma Acute Care Surg 2014;76(2):303–9. http://dx.doi.org/ 10.1097/TA.0000000000000112.
Sankari A, Vaughan S, Bascom A, et al. Sleepdisordered breathing and spinal cord injury: a state-of-theart review. Chest 2019;155(2):438–45. http://dx.doi.org/ 10.1016/j.chest.2018.10.002.
Du Moulin M, Taube K, Wegscheider K,et al. Home-based exercise training as maintenance after outpatient pulmonary rehabilitation. Respiration. 2009;77(2):139-45. doi: 10.1159/000150315. Epub 2008 Jul 31. PMID: 18667807.
Spruit MA, Pitta F, Garvey C, et al. ERS Rehabilitation and Chronic Care, and Physiotherapists Scientific Groups; American Association of Cardiovascular and Pulmonary Rehabilitation; ATS Pulmonary Rehabilitation Assembly and the ERS COPD Audit team. Differences in content and organisational aspects of pulmonary rehabilitation programmes. Eur Respir J. 2014 May;43(5):1326-37. doi: 10.1183/09031936.00145613. Epub 2013 Dec 12. PMID: 24337043.
Strijbos JH, Postma DS, van Altena R, et al.A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months. Chest 1996; 109: 366-72.
Holland AE, Mahal A, Hill CJ, et al. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial. Thorax. 2017 Jan;72(1):57-65. doi: 10.1136/thoraxjnl-2016-208514. Epub 2016 Sep 26. PMID: 27672116; PMCID: PMC5329049.
Fernández AM, Pascual J, Ferrando C, et al. Home-based pulmonary rehabilitation in very severe COPD: is it safe and useful? J Cardiopulm Rehabil Prev. 2009 Sep-Oct;29(5):325-31. doi: 10.1097/HCR.0b013e3181ac7b9d. PMID: 19561524.
Satıcı C, Arpınar Yiğitbaş B. Egzersiz Eğitimi. Gazi Gülbaş (Ed.), Pulmoner Rehabilitasyon içinde (s 32-36). https://www.solunum.org.tr/TusadData/Book /853/1412021103249-1072020171337
Puhan MA, Schünemann HJ, Frey M, et al. How should COPD patients exercise during respiratory rehabilitation? Comparison of exercise modalities and intensities to treat skeletal muscle dysfunction. Thorax. 2005 May;60(5):367-75. doi: 10.1136/thx.2004.033274. PMID: 15860711; PMCID: PMC1758898.
Leitl D, Glöckl R. Übersicht zur pneumologischen Rehabilitation [Overview on pulmonary rehabilitation]. Pneumologe (Berl). 2022 Jan 18:1-6. German. doi: 10.1007/s10405-021-00431-z. Epub ahead of print. PMID: 35069062; PMCID: PMC8764642
Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. 2007 May;131(5 Suppl):4S-42S. doi: 10.1378/chest.06-2418. PMID: 17494825.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002 Jul 1;166(1):111-7. doi: 10.1164/ajrccm.166.1.at1102. Erratum in: Am J Respir Crit Care Med. 2016 May 15;193(10):1185. PMID: 12091180.
Gosker HR, Schols AM. Fatigued muscles in COPD but no finishing line in sight. Eur Respir J 2008;31:693-4.
Lake FR, Henderson K, Briffa T, et al. Upper-limb and lower-limb exercise training in patients with chronic airflow obstruction. Chest 1990;97:1077–82.
O’Hara WJ, Lasachuk KE, Matheson, PC, et al. Weight training and backpacking in chronic obstructive pulmonary disease. Respir Care 1984;29:1202-10.
Kraemer WJ, Adams S, Cafarelli E, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2002;34:364-80.
Gosselink R, De Vos J, van den Heuvel SP, et al. Impact of inspiratory muscle training in patients with COPD: What is the evidence? Eur Respir J 2011;37:416- 25
Beykümül A. Göğüs Fizyoterapisi. Gazi Gülbaş (Ed.), Pulmoner Rehabilitasyon içinde (s 37-43). -https://www.solunum.org.tr/TusadData/Book /853/1412021103249-1072020171337.
Zach MS, Oberwaldner B. Chest Pahysiotherapy.In:Taussig L, Landau L editors.. Pediatric Respiratory Medicine. 2nd Ed. Pahiladelpahia: Mosby-Elsevier; 2008. p.241-52.
Mlcak R, Hedge SD, Herndon DN. Respiratory Care.In: Herndon D editor. Total Burn Care 4th Ed. PAHiladelPAHia: Elsevier-Saunders. 2012.p. 239-48.
Wollmer P, Ursing K, Midgren B, et al. Inefficiency of chest percussion in the Pahysical therapy of chronic bronchitis. Eur J Respir Dis 1985;66: 233–9.
Taha MM, Draz RS, Gamal MM, et al. Adding autogenic drainage to chest physiotherapy after upper abdominal surgery: effect on blood gases and pulmonary complications prevention. Randomized controlled trial. Sao Paulo Med J. 2021 Nov 15;139(6):556-563. doi: 10.1590/1516 3180.2021.0048. 0904221. PMID: 34787294.
Cox NS, McDonald CF, Alison JA, et al. Telerehabilitation versus traditional centre-based pulmonary rehabilitation for people with chronic respiratory disease: protocol for a randomised controlled trial. BMC Pulm Med. 2018 May 15;18(1):71. doi: 10.1186/s12890-018-0646-0. PMID: 29764393; PMCID: PMC5952573.
Kairy D, Lehoux P, Vincent C, et al. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil. 2009;31(6):427-47. doi: 10.1080/09638280802062553. PMID: 18720118.
Polat MG. Pulmoner rehabilitasyon açilimi: kavramlar ve uygulama modelleri. Bulletin of Thoracic Surgery/Toraks Cerrahisi Bülteni. 2015;6(1).
Marshall A, Medvedev O, Antonov A. Use of a smartphone for improved self-management of pulmonary rehabilitation. Int J Telemed Appl. 2008;2008:753064. doi: 10.1155/2008/753064. PMID: 18615186; PMCID: PMC2442909.
Vasilopoulou M, Papaioannou AI, Kaltsakas G, et al. Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits. Eur Respir J. 2017;49:1602129.
Lahham A, Holland AE. The Need for Expanding Pulmonary Rehabilitation Services. Life (Basel). 2021 Nov 15;11(11):1236. doi: 10.3390/life11111236. PMID: 34833112; PMCID: PMC8622005.
Cox N.S, Dal Corso S, Hansen H, et al. Telerehabilitation for chronic respiratory disese. Cochrane Database Syst. Rev. 2021, 1, CD013040.
Hill M, Jörgensen S, Levi R. Ryggmärgsskada – ett ovanligt tillstånd med komplexa behov [Spinal cord injury rehabilitation]. Lakartidningen. 2021 Sep 7;118:20231. Swedish. PMID: 34498238.
