Early Postoperative Physiotherapy to Prevent Respiratory Insufficiency After Elective Heart Surgery

This study aims to determine whether starting respiratory physiotherapy one hour after removal of the breathing tube following elective coronary artery bypass graft (CABG) surgery leads to better recovery than the current standard approach, in which physiotherapy begins on the first postoperative day. The study will evaluate whether earlier physiotherapy improves lung function, reduces postoperative pulmonary complications, shortens intensive care unit and hospital stay, decreases pain and anxiety, and improves overall recovery after surgery. The main question is whether very early postoperative respiratory physiotherapy provides additional benefits for patients recovering from elective heart surgery compared with standard postoperative care.

Inclusion Criteria: * Adults aged 18-80 years * Male and female participants * Elective coronary artery bypass grafting (CABG) * Body mass index (BMI) \< 30 kg/m² * Left ventricular ejection fraction (EF) \> 25% * Extubated on postoperative day 0 (POD 0) * Able and willing to provide written informed consent * Able to perform spirometry and follow study instructions Exclusion Criteria: * Refusal or inability to provide informed consent * Emergency CABG surgery * Previous cardiac surgery * Severe cardiac arrhythmias (e.g., ventricular tachycardia/fibrillation, third-degree atrioventricular block) * Previous stroke * Motor impairment of upper or lower extremities due to neurological or musculoskeletal disease * Dyskinesia * Not extubated on POD 0 * Significant postoperative neurological complications * Peripheral arterial disease of the lower extremities or previous lower-limb amputation * Acute or chronic pulmonary disease * Preoperative FEV1 \