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RIABILITAZIONE RESPIRATORIA: QUALE RUOLO PER IL FISIOTERAPISTA RESPIRATORIO ?

RIABILITAZIONE RESPIRATORIA: QUALE RUOLO PER IL FISIOTERAPISTA RESPIRATORIO ?. LAZZERI Marta A.O. NIGUARDA CA’ GRANDA MILANO. PULMONARY REHABILITATION ATS- ERS Statement 2006.

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RIABILITAZIONE RESPIRATORIA: QUALE RUOLO PER IL FISIOTERAPISTA RESPIRATORIO ?

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  1. RIABILITAZIONE RESPIRATORIA: QUALE RUOLO PER IL FISIOTERAPISTA RESPIRATORIO ? LAZZERI Marta A.O. NIGUARDA CA’ GRANDA MILANO

  2. PULMONARY REHABILITATION ATS-ERS Statement 2006 “Pulmonary rehabilitation is anevidence-based, multidisciplinary, and comprehensiveinterventionfor patients with chronic respiratory diseaseswho are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed toreduce symptoms, optimize functional status, increase participation, and reduce health care coststhrough stabilizing or reversing systemic manifestations of the disease. “

  3. CYCLETTE CAMMINO SOB dispnea LE fatica gambe

  4. FATTORI LIMITANTI L’ESERCIZIO NEL BPCO CENTRALI PERIFERICI ATROFIA MUSCOLARE DIMINUITA DENSITA’ CAPILLARE MALNUTRIZIONE ALTERAZIONI BIOENERGETICHE ACIDOSI METABOLICA RIDOTTA RISERVA VENTILATORIA AUMENTATA RICHIESTA VENTILATORIA IPERINFLAZIONE DINAMICA DEI POLMONI

  5. MALATTIA RESPIRATORIA MANIFESTAZIONI SISTEMICHE + SINTOMI A RIPOSO DISPNEA ASTENIA CIRCOLO VIZIOSO SINTOMI DURANTE ADL RIDUZIONE ATTIVITA’ FISICA DIMAGRIMENTO DEPRESSIONE DECONDIZIONAMENTO MUSCOLARE PRECOCE COMPARSA DISPNEA FATICA MUSCOLARE

  6. L’ALLENAMENTO RIDUCE LA DISPNEA RESPIRO E MIGLIORA LE CAPACITA’ MOTORIE DEI PAZIENTI CON BPCO MANCANZA DI RESPIRO INTENSA PIUTTOSTO INTENSA MODERATA LIEVE MOLTO LIEVE MOLTO MOLTO LIEVE NESSUNA Broncodilatatori Ossigenoterapia Allenamento TEMPO DURATA DELL’ATTIVITA’ MOTORIA (minuti) ATS Dyspnea A Consensus Statement, 1999 AJRCCM 159:321-340

  7. MODIFICAZIONI MUSCOLARI INDOTTE DALL’ESERCIZIO

  8. GOLD 2001TERAPIA DELLA BPCO AD OGNI STADIO

  9. 2004

  10. Female and male chronic obstructive pulmonary disease patients with severe dyspnea do not profit less from pulmonary rehabilitation. Lizak MK 2008;118:413-8 Δ %SWT Δ MRC 100 2.5 80 2 1.5 60 55 1 40 30 25 0.5 20 0 0 - 20 - 0.5 - 40 - 1 - 1.5 - 60 GRUPPO 1 GRUPPO 2 GRUPPO 3 GRUPPO 4 Δ %SWT Δ MRC

  11. Favors usual care Difference in six-minute walk test (meters) Favors rehabilitation

  12. 2009 RI-OSPEDALIZZAZIONI MORTALITA’

  13. HIGH WORK RATE TRAINING GROUP LOW WORK RATE TRAINING GROUP VE VO2 Heart rate VE VO2 Heart rate Lactate VE VO2 VCO2 Lactate VE VO2 VCO2 % Change % Change CASABURI R. et al ARRD 1991; 143 : 9 - 18

  14. New strategies to improve exercise tolerance in chronic obstructive pulmonary disease N.Ambrosino S.Strambi Drug Therapy Optimization Oxygen Supplementation Non Invasive Mechanical Ventilation Helium-Oxygen Breathing Interval Training Neuromuscular Electrical Stimulation Eur. Respir J 2004;24:313-32

  15. misusers , poor coordinators misusers , good coordinators Good users Good control Poor control

  16. Bourbeau J at al.Arch Itern Med 2003;163:583-91

  17. Round table Pulmonary Rehabilitation Moving Forward Fort Lauderdale Florida, 2008

  18. Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: A meta-analysis Effect of noninvasive positive pressure ventilation on mortality in patients (A) and COPD (B) presenting with acute respiratory failure A B Critical Care Medicine 1997; 25(10):1685-1692

  19. Critical Care Medicine 2002; 30:555-562

  20. Although noninvasive ventilation is not a highly sophisticated technique, it has several specific features that constitute a new area of knowledge for anyone who wants to implement this technique. Ignoring this may lead to disappointing results.  Brochard L. CCM 2000; 28(6):2139-2140

  21. CARICHI DI LAVORO Nava et al. Chest 1997;111:1631-38 INFERMIERE MEDICO Ft RESPIRATORIO

  22. Ripartizione dei CFU Corso Laurea I Livello Fisioterapista Riabilitazione ortopedica traumatologica e reumatologica Riabilitazione cardio-respiratoria 11% Altre Riabilitazione geriatrica Riabilitazione infantile Neuroriabilitazione adulto “Il Core Curriculum del Fisioterapista” Scienza Riabilitativa 2005;7:1

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