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Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study
Tiziano Cassina1, Alessandro Putzu1, Luisa Santambrogio1
1Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, 6900 Lugano, Switzerland.
Annals of Cardiac Anaesthesia
|July 12, 2016
Summary
Early mobilization after cardiac surgery is feasible and safe. This study demonstrates that a structured mobilization protocol, when closely monitored, can be safely implemented in the intensive care unit following major cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Intensive Care Medicine
- Hemodynamics
Background:
- Active mobilization is crucial for fast-track surgical recovery.
- Clinicians hesitate to mobilize patients post-surgery due to concerns about circulatory homeostasis.
- Potential issues include myocardial stunning, fluid shifts, and autonomic dysfunction.
Purpose of the Study:
- To assess the feasibility and safety of an early mobilization protocol after elective cardiac surgery.
- To evaluate the hemodynamic response to a structured mobilization procedure.
Main Methods:
- Observational study in a tertiary cardiovascular Intensive Care Unit.
- Prospective evaluation of 53 consecutive patients undergoing a two-staged mobilization procedure.
- Hemodynamic parameters (ScvO2, lactate, MAP, HR, RAP, SpO2) were monitored before, during, and after mobilization.
Main Results:
- All patients completed the mobilization protocol successfully.
- Mobilization led to increased lactate and decreased right atrial pressure (RAP) and central venous oxygen saturation (ScvO2).
- Mean arterial pressure (MAP) decreased by >10% in 34% of patients, with 17% requiring treatment; hypotensive patients showed a greater ScvO2 reduction.
Conclusions:
- Early mobilization after cardiac surgery is a safe procedure when conducted with close hemodynamic and clinical monitoring.
- The protocol was feasible in an intensive care setting.
- Hemodynamic parameters generally returned to baseline after mobilization, except for arterial lactate.
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