[Unresolved issues in the prevention of bronchopulmonary complications in a cardiac surgery patient from the standpoint of a rehabilitation therapist].

Bronchopulmonary complications are one of the leading causes of morbidity after cardiac surgery; they lengthen a patient's hospital stay and increase the cost of treatment. The most common postoperative bronchopulmonary complications include pneumonia, atelectasis, respiratory failure, pneumothorax, and bronchospasm. These complications are the consequences of anesthesia and surgical trauma aggravated by the presence of risk factors in the patient in the preoperative period such as any chronic disease involving the lungs, smoking history, persistent cough and / or wheezing, chest and spinal deformities, obesity, senior age. In addition, the presence of chronic heart failure, diabetes mellitus, and chronic kidney disease also increase the risk of developing bronchopulmonary complications. In the prevention and treatment of bronchopulmonary complications the clinical effectiveness of rehabilitation programs after coronary artery bypass grafting is undeniable. The effectiveness of the programs has been proven on the basis of both domestic and foreign long-term in-practice and scientific research. However, despite the significant advances in cardiac rehabilitation there are a number of unresolved issues. Is it possible in a short period of time of the first stationary rehabilitation stage to form the patient's skill to perform breathing exercises and, accordingly, to obtain the maximum effect in the prevention of bronchopulmonary complications? What factors can affect the speed of motor skill formation in the patient's mastering of breathing exercises? What should be the frequency of procedures per day and the number of exercises when a physical therapy instructor works with a patient to increase the effectiveness of the prevention of bronchopulmonary complications in the postoperative period? What category of patients is strictly required for the pre-rehabilitation stage? How should the pre-rehabilitation stage be organized and how long should it take? All these questions require the work-out and implementation of scientifically grounded individual rehabilitation programs with a step-by-step algorithm for managing the patient by a rehabilitation multi-team from the first hours after surgery with the mandatory inclusion of pre-rehabilitation and taking into account the social, anamnestic, clinical and psychological characteristics of the patient.