Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study.

Autor: Cassina T; Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, 6900 Lugano, Switzerland., Putzu A; Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, 6900 Lugano, Switzerland., Santambrogio L; Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, 6900 Lugano, Switzerland., Villa M; Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, 6900 Lugano, Switzerland., Licker MJ; Department of Anesthesiology, Pharmacology and Intensive Care, Faculty of Medicine, University Hospital of Geneva, 1206 Geneva, Switzerland.
Jazyk: angličtina
Zdroj: Annals of cardiac anaesthesia [Ann Card Anaesth] 2016 Jul-Sep; Vol. 19 (3), pp. 425-32.
DOI: 10.4103/0971-9784.185524
Abstrakt: 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 (ScvO 2 ), lactate concentrations, mean arterial pressure (MAP), heart rate (HR), right atrial pressure (RAP), and arterial oxygen saturation (SpO 2 ). 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 ScvO 2 (-7.4% [-5.9%, -9.9%], P = 0.0002), whereas HR and SpO 2 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 ScvO 2 (-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.
Databáze: MEDLINE
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