Early mobilization after transcatheter aortic valve implantation: observational cohort study.

Autor:	Lauck SB; School of Nursing, University of British Columbia, Centre for Heart Valve Innovation, St. Paul's Hospital, 5248-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.; St. Paul's Hospital, Vancouver, Canada., Yu M; School of Nursing, University of British Columbia, Centre for Heart Valve Innovation, St. Paul's Hospital, 5248-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada., Bancroft C; St. Paul's Hospital, Vancouver, Canada., Borregaard B; Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital.; Department of Clinical Research, University of Southern Denmark., Polderman J; St. Paul's Hospital, Vancouver, Canada., Stephenson AL; School of Nursing, University of British Columbia, Centre for Heart Valve Innovation, St. Paul's Hospital, 5248-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.; St. Paul's Hospital, Vancouver, Canada., Durand E; Department of Cardiology Normandie Université CHU RouenRouen France., Akodad M; Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, Massy, France., Meier D; Department of Cardiology, Lausanne University Hospital, Lausanne University, Lausanne, Switzerland., Andrews H; St. Paul's Hospital, Vancouver, Canada., Achtem L; St. Paul's Hospital, Vancouver, Canada., Tang E; School of Nursing, University of British Columbia, Centre for Heart Valve Innovation, St. Paul's Hospital, 5248-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.; St. Paul's Hospital, Vancouver, Canada., Wood DA; School of Nursing, University of British Columbia, Centre for Heart Valve Innovation, St. Paul's Hospital, 5248-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.; Centre for Cardiovascular Innovation, Vancouver, Canada., Sathananthan J; School of Nursing, University of British Columbia, Centre for Heart Valve Innovation, St. Paul's Hospital, 5248-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.; Centre for Cardiovascular Innovation, Vancouver, Canada., Webb JG; School of Nursing, University of British Columbia, Centre for Heart Valve Innovation, St. Paul's Hospital, 5248-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.; St. Paul's Hospital, Vancouver, Canada.; Centre for Cardiovascular Innovation, Vancouver, Canada.
Jazyk:	angličtina
Zdroj:	European journal of cardiovascular nursing [Eur J Cardiovasc Nurs] 2024 Apr 12; Vol. 23 (3), pp. 296-304.
DOI:	10.1093/eurjcn/zvad081
Abstrakt:	Aims: Early mobilization is associated with improved outcomes in hospitalized older patients. We sought to determine the effect of a nurse-led protocol on mobilization 4 h after transfemoral transcatheter aortic valve implantation (TAVI) across different units of care. Methods and Results: We conducted a prospective observational cohort single-centre study of consecutive patients. We implemented a standardized protocol for safe early recovery and progressive mobilization in the critical care and cardiac telemetry units. We measured the time to first mobilization and conducted descriptive statistics to identify patient and system barriers to timely ambulation. We recruited 139 patients (82.5 years, SD = 6.7; 46% women). At baseline, patients who were mobilized early (≤4 h) and late (>4 h) did not differ, except for higher rates of diabetes (25.5% vs. 43.9%, P = 0.032) and peripheral arterial disease (8.2% vs. 26.8%, P = 0.003) in the late mobilization group. The median time to mobilization was 4 h [inter-quartile range (IQR) 3.25, 4]; 98 patients (70.5%) were mobilized successfully after 4 h of bedrest; 118 (84.9%) were walking by the evening of the procedure (<8 h bedrest); and 21 (15.1%) were on bedrest overnight and mobilized the following day. Primary reasons for overnight bedrest were arrhythmia monitoring (n = 10, 7.2%) and haemodynamic and/or neurological instability (n = 6, 4.3%); six patients (4.3%) experienced delayed ambulation due to system issues. Procedure location in the hybrid operating room and transfer to critical care were associated with longer bedrest times. Conclusion: Standardized nurse-led mobilization 4 h after TF TAVI is feasible in the absence of clinical complications and system barriers. Competing Interests: Conflict of interest: S.B.L. has been a consultant for Edwards and Medtronic; J.S. has been a consultant for Edwards, Medtronic, and Boston Scientific and received research grants from Edwards and Medtronic; D.A.W. has received research grants from Abbott and Edwards; J.G.W. has been a consultant and/or received research support from Edwards, Abbott, Boston Scientific, and Vivitro Medical. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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