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2015v1.0
Cardiorespiratory
Physiotherapy
To Barbara, Jennifer and Ammani
Cardiorespiratory
Physiotherapy
ADULTS AND PAEDIATRICS
Fifth Edition
EDITED BY
ELEANOR MAIN BSc BA MSc PhD FCSP
Professor of Physiotherapy and Director of UCL Postgraduate Physiotherapy Programme,
UCL School of Life and Medical Sciences, University College London, London, UK
FOREWORD BY
BARBARA A WEBBER FCSP DSc(Hons)
Formerly Head of Physiotherapy, Royal Brompton Hospital, London, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2016
© 2016 Elsevier Ltd. All rights reserved.
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CONTENTS
3 THORACIC IMAGING.............................83
10 PAEDIATRIC INTENSIVE CARE .............455
Adults................................................................ 84
CONOR D COLLINS ■ SUSAN J COPLEY
Paediatric Mechanical Support ......................... 456
STEWART REID ■ MARK J PETERS
Paediatrics ....................................................... 108
JOY L BARBER ■ CHRISTOPHER D GEORGE
Physiotherapy Management of Ventilated
Infants and Children ........................................ 473
4 CARDIAC AND CARDIOVASCULAR ELEANOR MAIN ■ ALICIA J SPITTLE
DISEASES .............................................125
ANDREW D HIRSCHHORN ■ SEAN F MUNGOVAN ■
11 UPPER ABDOMINAL AND
DAVID A B RICHARDS CARDIOTHORACIC SURGERY
FOR ADULTS........................................513
5 RESPIRATORY DISEASES ......................163 DOA EL-ANSARY ■ JULIE C REEVE ■ LINDA DENEHY
ANNE E HOLLAND ■ JENNIFER A ALISON WITH CONTRIBUTIONS FROM SULAKSHANA BALACHANDRAN,
WITH A CONTRIBUTION FROM ALEX HARVEYAND MANDY JONES MICHELLE MULLIGAN
vii
viii CONTENTS
13 CARDIORESPIRATORY MANAGEMENT
OF SPECIAL POPULATIONS .................639
LINDA DENEHY ■ ELEANOR MAIN
WITH CONTRIBUTIONS FROM SARAH SMAILES, ANITA PLAZA,
JENNIFER PARATZ, LEANNE WILLIAMS, CLAIRE BRADLEY,
JACQUELINE L LUKE, JACQUELINE ROSS, BROOKE WADSWORTH,
KATE J HAYES, PRUE E MUNRO, PAUL AURORA, HELENA VAN
ASWEGEN, CRAIG A WILLIAMS, SARAH RAND, CATHERINE L
GRANGER, SUE BERNEY, AMYNORDON-CRAFT, LINDA DENEHY
FOREWORD
A s previous editors of this textbook we feel very There have been many changes in healthcare provi-
fortunate to have two remarkably busy professors of sion and we have come a long way since the early
physiotherapy who have carried forward the editor- days of ‘chest physiotherapy’ and ‘postural drainage’
ship of this book. They are both actively involved in prescribed by medical practitioners. This edition
leading cardiorespiratory physiotherapy research and recognizes physiotherapists as highly skilled indepen-
in teaching under- and postgraduate physiotherapists dent practitioners who are integral members of the
– Eleanor Main in London and Linda Denehy in multidisciplinary team. Their considerable depth of
Melbourne. knowledge and ability to interpret the many and ever-
The editors have brought together a wealth of increasing investigative tests enable them to identify
knowledge and evidence-based practice in respiratory appropriate treatments, exercise or education pro-
and cardiac medicine, physiotherapy and assessment grammes which meet the needs of individual patients.
techniques. Expert clinicians have contributed impor- This comprehensive new edition will be a great
tant new material in cardiorespiratory care. This inter- asset to both undergraduate and postgraduate physio-
national collaboration will facilitate further progress therapists and other health professionals interested in
for the bene t of both physiotherapists and patients. respiratory and cardiac problems. The increase in
Despite improvements in the design, quality and research and improvements in clinical practice, under-
rigour of allied healthcare research, there remains a taken during the 23-year lifetime of this textbook, are
paucity of evidence and a lack of clarity for best prac- in part due to imaginative methods, advances in tech-
tice in some clinical areas. In physiotherapy research nology and education by enthusiastic clinicians and
the ‘gold-standard’ randomized controlled trial is academics such as our two new editors. We believe that
often fraught with dif culty because of the inability to this edition will inspire another generation of physi-
conceal treatment allocation from participants. This otherapists to advance our profession.
can create uncontrollable bias resulting from patient
preference, particularly in studies which involve a BARBARA A WEBBER
long-term burdensome intervention. Therefore clini- JENNIFER A PRYOR
cal expertise currently remains an important element S AMMANI PRASAD
of evidence-based practice. 2016
ix
This pa ge inte ntiona lly le ft bla nk
ABOUT THE EDITORS
xi
xii Abo u t t h e ed it o r s
I t has been a real privilege to be invited to co-edit a chapter on the principles of exercise and physical
the fth edition of this core international cardiorespi- activity in cardiorespiratory populations and a chapter
ratory textbook. It has always been an important text on cardiorespiratory rehabilitation of special popula-
for undergraduate students around the world but is tions, for example, children or those with obesity,
also an enduringly valuable reference text for both cancer, liver disease or burns. Also new is the structure
experienced and novice practitioners involved with of the Physiotherapy Interventions chapter (previously
cardiorespiratory care. Techniques), which is now problem-based rather than
There have been some interesting and important alphabetical, and which hopefully will facilitate a
advances in cardiorespiratory physiotherapy in the clearer clinical reasoning pathway for students or
nine years since the rst printing of the fourth edition, novice practitioners.
and we have tried hard to include as many of the new In general, topics related to the care of children with
ideas and new pieces of evidence as possible. Having cardiorespiratory problems have now been incorpo-
said that, we acknowledge without reserve that we rated into appropriate sections of text throughout
‘stand on the shoulders of giants’, and many of the the book, either because there is signi cant overlap
essential timeless features of the earlier editions remain in approach or care between adults and children, or
intact. because understanding children with cardiorespira-
Before we started, we asked clinical and university tory problems facilitates better care of individuals
staff and students what they most wanted to see in this through the lifespan: problems in childhood frequently
new edition and, as a result, we have made changes that continue into adulthood. An exception is the division
we think will enhance the book. Some of the changes between the adult and paediatric ICU chapters, because
involved updating information or reorganizing where differences in the reasons for hospital admission and
it is found in the text, and some are entirely new chap- clinical and physiotherapy management of these pop-
ters. For example, the new rst chapter is an overview ulations remain substantial.
of cardiorespiratory anatomy and physiology essen- We are excited about and proud of the new edition
tials, with wonderful new illustrations, which we hope and hope that it continues to serve physiotherapy pro-
will be an outstanding clinical reference. Similarly, the fessionals in cardiorespiratory care around the world
assessment chapter, now doubled in length, provides for many years to come.
an expanded and structured systematic approach to EM
clinical cardiorespiratory assessment. Other new chap- LD
ters include two dedicated to cardiac and respiratory London and Melbourne 2016
problems or pathology, an outcome measures chapter,
xiii
This pa ge inte ntiona lly le ft bla nk
ACKNOWLEDGEMENTS
W e are indebted to all the expert contributors to It has been a pleasure working with Elsevier on this
this edition for the many tireless hours of work they text and all the members of the editorial and produc-
have surrendered to the cause. Many of the contribu- tion team: Rita Demetriou-Swanwick, Sally Davies,
tors were new and, on the whole, represent a truly Julie Taylor, Nicola Lally, Brett MacNaughton, Miles
international perspective on cardiorespiratory physi- Hitchen, Jo Collett, Kirsty Guest, Tharangini Sakthivel
otherapy. A few chapters involve collaborative writing and Rupa Rai. Thank you also to the Elsevier illustra-
partnerships between countries, and this enriches the tors for doing such a lovely job.
text and assures that physiotherapy practice can ulti- Finally we are eternally thankful to our colleagues,
mately aim to reach consensus about best practice families and friends who helped us choose the front
internationally. cover design and have tolerated neglect during this
We are also so very grateful to Barbara Webber, production, largely, but not exclusively without com-
Jennifer Pryor and Ammani Prasad (the ‘giants’ plaint! Colin, Daniel, Callum, the Shire folk, Gabrielle,
referred to in the Preface – although not in actual Andrew and Lara, when you read your signed copies
size!), for their extraordinary dedication over several carefully, you’ll know it was worth it!
decades to the clinical and academic advancement of EM
cardiorespiratory physiotherapy care. The continued LD
and growing appeal of this textbook over the past 23 2016
years is testament to their work, the high quality of the
book’s content and its ongoing usefulness in clinical
practice.
xv
This pa ge inte ntiona lly le ft bla nk
CONTRIBUTORS
xvii
xviii Co n t r ibu t o r s
LE SOLITAIRE DE LA FORÊT
Il pleut. La pluie fait un grand bruit, sur les feuilles, très haut. Je
ne la vois pas tomber. Elle suinte, elle pénètre, elle baigne toutes
choses. J’en profite pour écrire ces dernières lignes sur ma manière
de vivre. Je regrette d’avoir laissé à Singapour le cahier où j’ai
consigné les principaux événements de ma vie. Comme je rirais
maintenant, de sa complète stupidité, si je pouvais le relire ! Comme
je suis différent de ce que j’ai été ! Mais pourquoi s’en étonner ? Les
arbres perdent leur écorce et les animaux leur poil. L’homme se
dépouille aussi de ses vieilles idées et il en acquiert de nouvelles qui
sont plus jeunes et plus solides.
J’habite la cabane de l’ascète Chumbul. Depuis combien de
temps ? Je ne sais pas. Peut-être quelques jours, peut-être des
semaines. En marchant au hasard droit devant moi, au milieu d’un
épais massif de nipas, de pandanus et d’orchidées parasites, j’ai
rencontré cette cabane faite de branches grossièrement enfoncées
dans le sol et jointes avec des lianes. L’ascète Chumbul était assis à
côté de la cabane, les jambes croisées, en train de méditer. J’ai
attendu qu’il ait fini, puis j’ai toussé fortement pour éveiller son
attention. Je me suis approché de lui et j’ai compris, par le
mouvement en avant de son buste, que sa tête avait acquis cette
pesanteur que la mort donne au crâne humain. J’ai creusé une fosse
au pied d’un nagah en fleurs, avec un bizarre outil que j’ai trouvé
dans la cabane et j’ai enterré l’ascète. J’avais tout d’abord fabriqué
une croix avec deux morceaux de bois et j’allais la piquer en terre
quand je me suis souvenu que l’ascète était bouddhiste et que cet
emblème l’aurait peut-être contrarié, s’il avait pu le voir.
Maintenant j’habite sa maison, à côté de son tombeau et,
désireux de lui rendre honneur de quelque manière, en échange de
son hospitalité, je répète matin et soir, devant le nagah qui l’abrite,
cette sorte de prière ou d’invocation que je lui ai entendue chanter
dans le soir et qui est revenue à ma mémoire :
— Om, Mani, Padmé, Aum.
Je n’imaginais pas qu’on pût être si bien, solitaire, au milieu
d’une immense, d’une profonde, d’une amicale, d’une maternelle
forêt. Comme cet ascète était avisé sous sa déplorable maigreur ! Il
avait trouvé la meilleure manière de vivre. Je viens de penser, tout
d’un coup, aux milliers de sots qui montent en calèche l’avenue
royale de Singapour, qui échangent entre eux des saluts ou
contemplent les magasins chinois et je suis parti d’un éclat de rire si
bruyant qu’il a presque couvert le bruit de la pluie sur les feuilles.
Eva m’a dit que cette forêt est une des plus anciennes de la terre
et qu’elle renferme de grands mystères.
Un de ces mystères doit être relatif à un éléphant étrange que j’ai
aperçu deux ou trois fois, tantôt cheminant avec lenteur dans un
sentier, tantôt arrachant de jeunes branches pour s’en nourrir. Il est
couleur de cendres et ressemble singulièrement à Jéhovah que j’ai
tué. Je pourrais même croire que c’est lui qui a échappé à mon coup
de fusil si je n’avais pas eu les échos de diverses plaintes de
propriétaires de Singapour arrivées à la résidence au sujet des
émanations causées par son cadavre. Cet éléphant n’est pas très
craintif. Il gambade parfois joyeusement, comme faisait Jéhovah
quand il m’apercevait, et tout à l’heure il s’est tenu immobile à une
petite distance de moi, la trompe basse, avec une tristesse infinie
dans ses petits yeux. Je suis surpris de la manière dont il glisse
plutôt qu’il ne marche et dont il disparaît tout à coup sans que je
puisse savoir par où il est passé.