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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY February 2013 | Archived Issues

Surgeons Asked to Review Use of CPT

Harry C. Sax, MD, MHCM, FACS, is asking Cedars-Sinai surgeons for help in focusing the role of respiratory therapy in patient care. There are specific patients who will benefit, notes Sax, senior physician liaison for Cedars-Sinai Medicine and executive vice chair of Surgery. We want to make sure that we deploy resources where they can do the most good.

Chest physiotherapy, including percussion and postural drainage, is beneficial in a number of conditions: significant sputum production in patients needing assistance in clearing secretions; acute, segmental or lobar atelectasis caused by secretion retention; or cystic fibrosis, bronchiectasis and pulmonary abscess.

However, Cedars-Sinai data and chart review indicate that CPT is being routinely ordered postoperatively when literature suggests that there is no benefit. Specifically, simple atelectasis does not need CPT, and in fact, an Annals of Surgery article showed that CPT was associated with significantly more frequent and more severe atelectasis after cardiac surgery.  

Surgeons are asked to review their standing postoperative order sets to assure that we are ordering CPT in patients who will truly benefit. After review by various departmental PICs, including the Department of Surgery, we are recommending that CPT treatment should be discontinued after 24 hours if post-treatment outcome evaluation indicates the patient will not benefit further. Surgeons may receive calls from Respiratory Therapy confirming this assessment.

Chest Physiotherapy Recommendations - February 2013 (PDF)