Respiratory Rehabilitation

Respiratory Rehabilitation encompasses the management of patients with pulmonary pathologies, ranging from bronchial destruction to tracheostomy management, to selecting the most suitable aerosol therapy for the patient and their motor reconditioning. The respiratory physiotherapist is a crucial member of the medical team that takes care of a critically ill patient, alongside the anesthetist, pulmonologist, cardiologist, thoracic surgeon, and others.

They are present in both intensive care units and pulmonary outpatient clinics, as well as in inpatient wards, where they play different roles based on the needs. The specific tasks of the respiratory physiotherapist may include:

• Weaning from tracheostomy
• Extubation assessment
• Management of aerosol therapy
• Administration of oxygen therapy
• Management of non-invasive mechanical ventilation (NIMV)
• Bronchial clearance
• Specific motor reconditioning for chronic respiratory patients
• Use of respiratory aids
• Assessment and execution of respiratory tests (spirometry, polysomnography)
• Treatment of sleep disorders

The respiratory physiotherapist is a highly specialized healthcare professional in pulmonary pathologies. Before each patient intervention, they conduct a thorough clinical and diagnostic assessment to understand the full complexity of the individual. This includes reviewing blood tests, radiological reports, and medications, consulting with the referring specialist, and designing an individualized treatment plan for the patient. They also manage all respiratory issues related to neuromuscular pathologies, such as ALS, multiple sclerosis, and spinal cord injuries.

Some of the well-known pathologies treated by respiratory physiotherapists include:

• COPD
• Asthma
• Sequelae of pneumonia
• Post-thoracic surgery outcomes
• Cystic Fibrosis
• Bronchiectasis
• Emphysema
• Pulmonary Fibrosis

WHAT DOES A RESPIRATORY PHYSIOTHERAPY SESSION INVOLVE?

Following assessment, depending on the type of issue the patient presents, we can structure the session as follows:

• Bronchial clearance: a series of exercises and positioning maneuvers allowing the patient to expel (expectorate) excessive secretions exacerbating the clinical condition.
• Titration of oxygen therapy: based on the patient’s motor needs, the therapist adjusts the amount of oxygen therapy.
• Motor reconditioning: development of an exercise plan aimed at improving daily management and patient autonomy, always monitoring parameters such as oxygen saturation (SpO2) and heart rate (HR).
• Management of vital parameters and dyspnea: throughout the session, the respiratory therapist will monitor the patient’s clinical conditions, assessing heart rate, blood oxygen levels, and adjusting them according to the set activities and goals, also managing any dyspnea experienced during therapy.

Additionally, the respiratory therapist also oversees non-invasive assisted ventilation, both at home and in the ward, such as CPAP, ensuring the patient achieves the best adherence and optimal outcomes possible.