Efficacy of Early and Enhanced Respiratory Physiotherapy and Mobilization after On-Pump Cardiac Surgery: A Prospective Randomized Controlled Trial

Abstract

Background: This randomized controlled trial aimed to investigate the influence of physical activity and respiratory physiotherapy on zero postoperative day on clinical, hemodynamic and respiratory parameters of patients undergoing cardiac surgeries under extracorporeal circulation. Methods: 78 patients undergoing coronary artery bypass graft (CABG) or/and valvular heart disease surgeries were randomly assigned into an early and enhanced physiotherapy care group (EEPC group; n = 39) and a conventional physiotherapy care group (CPC group; n = 39). Treatment protocol for the EEPC group included ≤3 Mets of physical activity and respiratory physiotherapy on zero post-operative day and an extra physiotherapy session during the first three post-operative days, whereas the CPC group was treated with usual physiotherapy care after the first post-operative day. The length of hospital and intensive care unit (ICU) stay were set as the primary study outcomes, while pre- and post-intervention measurements were also performed to assess the oxymetric and hemodynamic influence of early mobilization and physiotherapy. Results: Participants’ mean age was 51.9 ± 13.8 years. Of them 48 (61.5%) underwent CABG. Baseline and peri-procedural characteristics did not differ between the two groups. The total duration of hospital and ICU stay were significantly higher in the CPC group compared to the EEPC group (8.1 ± 0.4 days versus 8.9 ± 0.6 days and 25.4 ± 3 h versus 23.2 ± 0.6 h, p < 0.001, respectively). Statistically significant differences in pre-intervention oxygen saturation, and post-intervention PO2 and lactate levels were also observed between the two groups (p = 0.022, 0.027 and 0.001, respectively). Conclusion: In on-pump cardiac surgery, early and enhanced post-procedural physical activity (≤3 METS) can prevent a prolonged ICU stay and decrease the duration of hospitalization while ameliorating post-operative hemodynamic and oxymetric parameters.

Factors Determining the Functional State of Cardiac Surgery Patients with Complicated Postoperative Period

“…It may also require additional staffing with adequate training in the rehabilitation of these patients [ 22 ]. In addition, postoperative in-hospital mobilization should be adjusted to the patient’s functional status at that specific moment, building up from sitting in a chair (which should be initiated as early as possible, including in the ICU) and increasing the functional status by walking, biking on an exercise bike or even walking on stairs [ 23 , 24 ]. Otherwise, early mobilization may not lead to a reduction in hospitalization times or a reduction in the cost of treatment [ 11 ].…”

A Mobilization Poster stimulates Early In-Hospital Rehabilitation after Cardiac Surgery: A prospective sequential-group study

“…The early mobilization protocol is comparable in physical activity to other published protocols [32]. Afxonidis et al intensi ed early postoperative physiotherapy sessions after cardiac surgery starting at the ICU, and reached milestones during hospital stay compared to our Day 2 protocol [15]. Physical therapists in Australia and New Zealand reported in a national survey that all patients are sitting out of bed at rst postoperative day and 20% completed one ight of stairs on day 4 after uncomplicated CABG [14].…”

“…In-hospital exercises include breathing techniques, transfer between bed and chair and walking along the ward [8]. This leads to less pain and depression as well as decreased length of stay [15], and these outcomes are associated with lower mortality, morbidity, and costs [16]. Early mobilization strategies increased 6-minute walking assessment distance from 377m to 444m [17], but did not meet the minimal clinically important difference [18].…”

A mobilization poster stimulates early in-hospital rehabilitation after cardiac surgery: a prospective sequential-group study

“…The early mobilization protocol is comparable in physical activity to other published protocols [32]. Afxonidis et al intensified early postoperative physiotherapy sessions after cardiac surgery starting at the ICU, and reached milestones during hospital stay compared to our Day 2 protocol [15]. Physical therapists in Australia and New Zealand reported in a national survey that all patients are sitting out of bed at first postoperative day and 20% completed one flight of stairs on day 4 after uncomplicated CABG [14].…”

“…In-hospital exercises include breathing techniques, transfer between bed and chair and walking along the ward [8]. This leads to less pain and depression as well as decreased length of stay [15], and these outcomes are associated with lower mortality, morbidity, and costs [16]. Early mobilization strategies increased the exercise capacity (6-min walking assessment distance from 377 to 444 m) [17], but did not meet the minimal clinically important difference [18].…”