Thoracic Surgery
Conditions
Keywords
Fast track, rehabilitation, post operative complications
Brief summary
This prospective, randomized study is designed to evaluate the effectiveness of postoperative care pathway using the Fast Track Rehabilitation protocol (FTR) in comparison with the traditional postoperative care. In order to conduct this study, patients having a thoracic surgery will be randomly attributed to FTR protocol group or control group.
Detailed description
Traditionally, patients who underwent thoracic surgery have been treated with a classical protocol which include; bed rest, ambulation prohibited for 24-48 hours and starvation for several postoperative days till the recovery of bowel. Some studies reported the efficacy of early rehabilitation protocols or FTR protocols in thoracic surgery to reduce postoperative complications and to minimize hospital stay. But these studies are few and retrospective. Prospective randomized trials focuses based on the fast track regimen or medical fast track that interest only on the medical component . This prospective, randomized study is designed to evaluate the effectiveness of postoperative care pathway using FTR protocol in comparison with the traditional postoperative care. In order to conduct this study, patients having a thoracic surgery will be randomly attributed to FTR protocol group or control group.
Interventions
BEHAVIORALEarly exercises
In postoperative phase: Early exercises: within the first hour ;setting a half bed position, deep breathing and coughing . In the second hour, curbing vagal malaise and performing relaxation movements. In the third hour, walking about 20 to 30 minutes.
BEHAVIORALRemoving urinary probe and all catheters.
In postoperative phase : Removing urinary probe and all catheters.
BEHAVIORALEarly alimentation
In postoperative phase :Early alimentation: in the first hour to the second hour .
BEHAVIORALcommun interventions
* In preoperative phase: stopping smoking at least 2 weeks, hospitalization and balanced alimentation one day before the surgery. * In peroperative phase : no use of benzodiazepines in the anesthesia , selective intubation , maintaining vital parameters as normal and using a mini invasive surgical approach ( video thoracoscopy , video assisted thoracoscopy , thoracotomy with preservation of the posterior muscles of the chest wall , preservation of Serratus anterior and the front part of Latissimus Dorsi ). * In postoperative phase : Immediate extubation ( less than 30 minutes from the surgery end) , peridural or paravertebral or intercostal block analgesia , no use of abusive antibiotic , all analgesic drugs are permitted if there are no contraindications and physiotherapy from the 6th hour.
Sponsors
Community medicine department -Habib Bourguiba University Hospital
Habib Bourguiba University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* All patients who have lung surgery during the study period after their consents are included.
Exclusion criteria
* Patients who have bad general state are unable to move or require a wake in the resuscitation. * The Patients with thoracic soft tissue surgery. * patients having mediastinoscopy, surgery of the chest wall or mediastinum.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Complications: Atelectasis or re-expansion failure or pneumonic infection | within postoperative 30 days | discharge criteria: * Chest tube removal * Unassisted ambulation * Afebrile without major complications * Willing discharge |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain | in 1st hour , 2nd hour , 3rd hour , 6th hour 24th hour , 48th hour at the postoperative , within postoperative 30 days | score measured by the Visual Analog Scale. |
| The Length of Hospital Stay | within postoperative 30 days | — |
| Thoracic surgery postoperative Complications | within postoperative 30 days | During the First Admission : Prolonged bubbling |
| Surgery postoperative Complications : pulmonary embolism or cardiac arrhythmia or pleural empyema | within postoperative 30 days | — |
Countries
Tunisia
Contacts
Primary ContactAhmed Ben Ayed, Resident
Outcome results
None listed