Precision implementation of early ambulation in elderly patients undergoing off-pump coronary artery bypass graft surgery: a randomized-controlled clinical trial

Abstract

Background Although early ambulation (EA) is associated with improved outcomes in post-operative patients, implementation of EA in elderly patients is still a challenge. In this study, we aimed to design and assess a precision early ambulation program for cardiac rehabilitation. Methods We conducted a single-center, randomized and controlled clinical trial in elderly patients aged over 60 years after off-pump coronary artery bypass graft (OPCABG) surgery. Patients were randomly assigned to a precision early ambulation (PEA) group or a routine ambulation (Control) group. Age-predicted maximal heart rate (APMHR) and maximal oxygen uptake (VO2max) were used as a reference to formulate and monitor the PEA regimen. The primary end-point was the postoperative length of stay in hospital (PLOS). The secondary end-points included 90-day mortality, incidence of early discharge, laboratory tests, length of ICU stay, the incidence of multiple organ complications and post-traumatic stress disorder (PTSD). Ambulation outcomes were also recorded. Results In total, 178 patients were enrolled (n = 89 per group). In the intent-to-treat analysis, PLOS in the PEA group was shorter than that in the Control group (9.04 ± 3.08 versus 10.09 ± 3.32 days, respectively. Mean difference 1.045 days; 95% confidence interval [CI] 0.098–1.992; P = 0.031 in the unadjusted model; mean difference 0.957 days; CI 0.007–1.907; P = 0.048 in adjusted model). The incidence of early discharge differed significantly between the PEA and control groups (41[46.1%] versus 24[27.0%] patients, respectively. Odds ratio [OR] 0.432; CI 0.231–0.809; P = 0.009 in unadjusted model; OR 0.466; CI 0.244–0.889, P = 0.02 in adjusted model). The time of first bowel movement, partial pressure O2 and post-traumatic stress disorder score in the PEA group were better than those in the Control group. Participants walked much longer distances on day 3 in the PEA group than those in the Control group (76.12 ± 29.02 versus 56.80 ± 24.40 m, respectively, P < 0.001). Conclusion APMHR and VO2max are valuable for implementation of PEA according to an established security threshold. PEA after OPCAPG surgery is safe and reliable for elderly patients, not only reducing the hospital stay, but also improving their physiological and psychological symptoms. Trial registration This study is a component of a protocol retrospectively registered: Application of ERAS in cardiovascular surgery. Trial registration number: ChiCTR1800018167. Date of registration: 3rd September, 2018. URL of trial registry record: http://www.chictr.org.cn/index.aspx

Effect of Early Exercise Rehabilitation on Cardiopulmonary Function and Quality of Life in Patients after Coronary Artery Bypass Grafting

“…The indicators of cardiopulmonary exercise test were commonly used include VO2max, AT, etc., of which VO2max is an important indicator of cardiopulmonary function and aerobic endurance [ 17 ]; AT can reflect the potential of the body to tolerate load [ 18 ]. The results of this study showed that 6MWT, VO2max, and AT in study group were significantly higher than those in the control group after intervention, suggesting that early exercise rehabilitation can effectively improve cardiopulmonary function and exercise endurance in patients after CABG.…”

Relevância Da Deambulação Precoce No Tempo De Internação Hospitalar De Pacientes Idosos

“…No estudo de Cui et al 9 foi possível analisar dois grupos, um com deambulação precoce de precisão (PEA) e outro com reabilitação de rotina em idosos, cada grupo com 89 participantes. Em ambos os grupos o tratamento ofertado foi avaliado por meio da mensuração com foco na frequência cardíaca máxima prevista para a idade (APMHR) e no VO²max, como critérios de segurança.…”

“…Os protocolos de PEA foram implantados por um grupo de seis terapeutas reabilitadores através de um protocolo individualizado, dividido em quatro etapas, desde o sentar na beira do leito, até a aquisição de atividades funcionais com maior independência, conferidas no terceiro dia pós-operatório. Já no grupo de reabilitação ciência plural de rotina, os pacientes realizaram um programa de exercícios de acordo com seus limiares, que envolviam ficar em pé ou não no segundo e terceiro dia pós-operatório 9 .…”

“…Esse estudo também revelou que o APMHR e o VO²max são critérios muito importantes para a avaliação de um limiar seguro de esforço, mostrando-se valioso na implementação da PEA. Em contrapartida, não houve diferenças significativas entre os grupos PEA e Controle em termos de permanência na Unidade de Terapia Intensiva (UTI) 9 .…”

Determining Factors for Independent Walking in Patients Undergoing Cardiovascular Surgery: Differences between Coronary Artery Bypass Grafting, Heart Valve Surgery, and Aortic Surgery

“…Early achievement of independent walking after cardiovascular surgery plays an important role in independence in daily living, management of cardiac disease, and prevention of the recurrence of disease [1]. It is recommended that cardiac rehabilitation (CR) after cardiovascular surgery should be started in the early post-operative period, within 24-72 h after surgery [1][2][3]. Early CR is effective in reducing post-operative complications, in improving exercise tolerance, and in preventing delirium [1,[4][5][6][7][8].…”