Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study.
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Date
2016-07
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Abstract
Background: Active mobilization is a key component in fast‑track surgical strategies. Following major
surgery, clinicians are often reluctant to mobilize patients arguing that circulatory homeostasis would
be impaired as a result of myocardial stunning, fluid shift, and autonomic dysfunction. Aims: We
examined the feasibility and safety of a mobilization protocol 12–24 h after elective cardiac surgery.
Setting and Design: This observational study was performed in a tertiary nonacademic cardiovascular
Intensive Care Unit. Materials and Methods: Over a 6‑month period, we prospectively evaluated the
hemodynamic response to a two‑staged mobilization procedure in 53 consecutive patients. Before, during,
and after the mobilization, hemodynamics parameters were recorded, including the central venous oxygen
saturation (ScvO2), lactate concentrations, mean arterial pressure (MAP), heart rate (HR), right atrial
pressure (RAP), and arterial oxygen saturation (SpO2). Any adverse events were documented. Results: All
patients successfully completed the mobilization procedure. Compared with the supine position, mobilization
induced significant increases in arterial lactate (34.6% [31.6%, 47.6%], P = 0.0022) along with reduction
in RAP (−33% [−21%, −45%], P < 0.0001) and ScvO2 (−7.4% [−5.9%, −9.9%], P = 0.0002), whereas HR
and SpO2 were unchanged. Eighteen patients (34%) presented a decrease in MAP > 10% and nine of
them (17%) required treatment. Hypotensive patients experienced a greater decrease in ScvO2 (−18 ± 5%
vs. −9 ± 4%, P = 0.004) with similar changes in RAP and HR. All hemodynamic parameters, but arterial
lactate, recovered baseline values after resuming the horizontal position. Conclusions: Early mobilization
after cardiac surgery appears to be a safe procedure as far as it is performed under close hemodynamic
and clinical monitoring in an intensive care setting.
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Keywords
Anesthesia, Cardiac surgery, Hemodynamics, Hypotension, Perioperative care
Citation
Cassina Tiziano, Putzu Alessandro, Santambrogio Luisa, Villa Michele, Licker Marc Joseph. Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study. Annals of Cardiac Anaesthesia. 2016 July; 19(3): 425-432.