[Preparing for thoraco-abdominal surgery: What's in it for the physiotherapist?] / Préparation à une chirurgie thoraco-abdominale : Quelle place pour le masseur-kinésithérapeute ?

INTRODUCTION: Physiotherapy before thoraco-abdominal surgery aims to optimize the patient's cardiorespiratory fitness, in order to limit his alterations in the immediate postoperative period and to reduce postoperative morbidity. This support also aims to make eligible for surgery the patient who is not initially. This review of the literature addresses chest physiotherapy and exercise training that the patient can benefit. STATE OF ART: Scientific evidence remains relatively weak for physiotherapy before thoraco-abdominal surgery, especially for bronchial drainage and incentive spirometry techniques. However, inspiratory muscle training and prehabilitation seem interesting for increasing exercise capacity and reducing morbidity. These last two innovative modalities that can be carried out at home are particularly relevant for patients who present a high risk of complications or who cannot access conventional programs. Smoking cessation, nutritional care and educational support are areas that the physiotherapist must integrate into his practice. PERSPECTIVES: In a decisional algorithm, we suggest 4 types of programs ranging from a simple preoperative education to an intensive multimodal program. This remains to be evaluated in current practice. CONCLUSIONS: The physiotherapist must fully participate in assessing the risk of postoperative morbidity in the context of thoraco-abdominal surgery. He must also identify the most efficient modalities within the delay imposed by the date of surgery. It is also necessary that the latter learn to identify the patient at higher risk of postoperative complications in order to adapt the preoperative management according to the levels of scientific evidence.

[Physiotherapy and COVID-19. From intensive care unit to home care-An overview of international guidelines]. / Kinésithérapie et COVID-19 : de la réanimation à la réhabilitation à domicile. Synthèse des recommandations internationales.

INTRODUCTION: The new coronavirus disease 2019 (COVID-19) is responsible for a global pandemic and many deaths. This context requires an adaptation of health systems as well as the role of each healthcare professional, including physiotherapists. STATE OF THE ART: In order to optimize the management of people with COVID-19, many savant societies published guidelines about physiotherapy interventions within the crisis but none offered a global overview from the intensive care unit to home care. Therefore, the aim of this review is to offer an overview of recommended physiotherapy interventions in order to facilitate the management of these patients, whatever the stage of the disease. PERSPECTIVES: Owing to the emergent character of the COVID-19, actual guidelines will have to be adjusted according to the evolution of the pandemic and the resources of the hospital and liberal sectors, in particular for the long-term follow-up of these patients. Current and future research will aim to assess the effectiveness of physiotherapy interventions for people with COVID-19. CONCLUSION: The emergence of COVID-19 required a very rapid adaptation of the health system. The role of physiotherapists is justified at every stage of patients care in order to limit the functional consequences of the disease.

[Noninvasive ventilation during pulmonary rehabilitation in COPD patients]. / Ventilation non invasive au cours de la réhabilitation respiratoire des patients atteints de BPCO.

INTRODUCTION: Pulmonary rehabilitation is currently the gold standard treatment for patients with chronic obstructive pulmonary disease (COPD). However, the workload achieved may be insufficient to obtain physiological benefits because of the restricted respiratory capacity. BACKGROUND: In patients with COPD, changes in flow as well as biomechanical factors (distension) compromise respiratory adaptation to exertion. Some studies have shown that noninvasive ventilation (NIV) during exercise has a positive effect on respiratory muscle workload, physiological parameters and perceived exertion. However the evidence remains insufficient regarding the effects of the NIV during comprehensive pulmonary rehabilitation programs. OBJECTIVES: The identification of criteria which determine responsive patients is necessary in order to reduce human and time costs and to optimize the use of NIV during exercise. CONCLUSIONS: NIV is used during training to overcome dyspnoea and to increase muscle workload. Further studies are needed to verify the effectiveness of NIV in pulmonary rehabilitation.