Cardiovascular and Pulmonary Intervention and Management
Cardiovascular and pulmonary intervention
Rehabilitation is a prescription, not a generic workout. For cardiac patients, phase-based programs progress from monitored inpatient mobility to outpatient endurance and resistance training. For pulmonary patients, pulmonary rehabilitation combines aerobic and strength training, breathing retraining, airway clearance, and self-management education.
Airway clearance techniques include huffing, active cycle of breathing, positive expiratory pressure, oscillating devices, and high-frequency chest wall oscillation. Choose based on secretion burden, cough effectiveness, and tolerance. Breathing strategies-pursed-lip breathing, diaphragmatic breathing, and pacing-reduce dyspnea and improve efficiency. Inspiratory muscle training may help selected patients.
Monitor vital signs, SpO2, symptoms, Borg rating, and telemetry when indicated. In patients with COPD and chronic hypercapnia risk, titrate oxygen to a target range, commonly 88–92%, rather than giving high-flow oxygen reflexively. Beta-blockers can blunt heart rate, so use perceived exertion and clinical signs. Anticoagulation, diuretics, and vasoactive medications alter exercise response and require coordination with the team.
Traps
Do not withhold mobilization solely because of age or a monitor. Do not ignore new chest pain, palpitations, dizziness, or a falling blood pressure. Do not treat a desaturation with oxygen alone without checking technique, fatigue, bronchospasm, or equipment.
Worked example. A patient with COPD walks 50 meters and desaturates from 94% to 85%. Stop, sit upright, check the device and interface, and titrate oxygen to the target range. Reassess; if saturation remains below target or symptoms worsen, end the session and escalate. Rule of thumb: train to symptoms and signs, not to a single number.