3.3.1. Prehabilitation

The detrimental effects of prolonged bed rest in an intensive care unit have been extensively investigated. Prolonged immobilization contributes to decreased cardiac output; the development of complications such as deep venous thrombosis, pneumonia, pressure sores, and muscle atrophy; and a decline in aerobic capacity, which occurs as early as within the first few postoperative days [16]. Muscle weakness has been observed in nearly 50% of intensive care patients and is strongly associated with increased short- and long-term morbidity, the deterioration of physical capacity, and an increase in mortality [17,18]. Furthermore, patients undergoing cardiac surgery are at a risk of postoperative pulmonary complications leading to increased postoperative morbidity and mortality. These include cardiogenic pulmonary edema, acute respiratory distress syndrome, pneumothorax, pleural effusion, atelectasis, pneumonia, prolonged mechanical ventilation, and phrenic nerve injury [19]. Contributing factors include age over 70 years, diabetes mellitus, body mass index > 28, and preoperative arrhythmias [20]. Thus, preoperative assessment should entail the testing of functional capacity and frailty for an appropriate postoperative risk estimation. The inability to climb two flights

of stairs or the presence of frailty is associated with a high risk of postoperative cardiac events [21,22]. Cardiac prehabilitation implements specific interventions before cardiac surgery to facilitate better postoperative outcomes [23].

Detailed goals of prehabilitation include:


Prehabilitation comprises:


Respiratory physiotherapy is of paramount importance and includes such practices as secretion aspiration, oxygen therapy, change in body positions, postural drainage, deep breathing/coughing exercises, inspiratory muscle training, and the use of incentive spirometers [24–26].
