The impact of mobilization protocols on the length of postoperative hospitalization among cardiac surgery patients

Authors

  • V. V. Vitomskyi GI “Scientific and Practical Medical Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine” (Ukrainian Children’s Cardiac Center), Kyiv, Ukraine, Ukraine
  • O. B. Lazarieva National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine
  • E. Yu. Doroshenko Zaporizhzhia State Medical University, Ukraine, Ukraine
  • M. V. Vitomskа National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine, Ukraine
  • T. М. Kovalenko National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine, Ukraine
  • A. М. Hertsyk Ukrainian Catholic University, Lviv, Ukraine, Ukraine
  • S. V. Gavreliuk National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine, Ukraine

DOI:

https://doi.org/10.14739/2310-1210.2021.2.228781

Keywords:

exercise therapy, mobilization, cardiac surgery

Abstract

The aim. To determine the impact of implementing the extra early mobilization protocol (EEM) on the length of intensive care unit (LICU) stay and postoperative unit (LPOU) stay and to assess the role of age, heart contractility, functional class and surgical outcomes.

Materials and methods. Participants – adult patients of 2018–2019 with less than 24-hour artificial lung ventilation (ALV). The first group were treated according to the early mobilization protocol (EM, patients of 2018); the second group were treated according to the EEM protocol (patients of 2019). Design: a retrospective analysis. Settings: cardiosurgical unit. Interventions: the major difference is that the resources of patient mobilization team have expanded since 2019, namely it included a physical therapist, which made it possible to modify the EM protocol (standing on the 2 postoperative day (POD), activation with the help of medical staff, respiratory exercise) to the EEM protocol (standing on the 1 POD following consultation with an anesthesiologist, exercises with a physical therapist, respiratory exercise). The main outcomes: LICU, LPOU and total postoperative hospitalization (LTPO) (number of nights).

Results. There were no differences between the EEM and EM groups in LICU (3 (2; 4) vs. 2 (2; 4); P = 0.182), LPOU (7 (6; 10) vs. 8 (6; 10); P = 0.118), LTPO (10 (8; 13) vs. 10 (9; 13); P = 0.308). Correlation analysis revealed absence, weak and very weak relations between the LICU, LPOU, LTPO indicators and other criteria, including age, ejection fraction, ALV.

Conclusions. The effectiveness of the EEM protocol seems doubtful to reduce LICU, LPOU, and LTPO as compared to the EM protocol. The obtained results also raise the importance of physical therapist time management.

Author Biographies

V. V. Vitomskyi, GI “Scientific and Practical Medical Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine” (Ukrainian Children’s Cardiac Center), Kyiv, Ukraine

PhD, Lecturer of the Department of Physical Therapy and Ergotherapy, National University of Ukraine on Physical Education and Sport; Physical therapist

O. B. Lazarieva, National University of Ukraine on Physical Education and Sport, Kyiv

PhD, DSc, Professor, Head of the Department of Physical Therapy and Ergotherapy

E. Yu. Doroshenko, Zaporizhzhia State Medical University, Ukraine

PhD, DSc, Professor of the Department of Physical Rehabilitation, Sports Medicine, Physical Training and Health

M. V. Vitomskа, National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine

Lecturer of the Department of Physical Therapy and Ergotherapy, Postgraduate student of the Department of Physical Therapy and Ergotherapy

T. М. Kovalenko, National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine

MD, PhD, Associate Professor of the Department of Physical Therapy and Ergotherapy

A. М. Hertsyk, Ukrainian Catholic University, Lviv, Ukraine

PhD, DSc, Professor of the Department of Physical Therapy and Ergotherapy

S. V. Gavreliuk, National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine

MD, PhD, Associate Professor of the Department of Physical Therapy and Ergotherapy

References

Surkan, M. J., & Gibson, W. (2018). Interventions to Mobilize Elderly Patients and Reduce Length of Hospital Stay. Canadian Journal of Cardiology, 34(7), 881-888. https://doi.org/10.1016/j.cjca.2018.04.033

Adler, J., & Malone, D. (2012). Early Mobilization in the Intensive Care Unit: A Systematic Review. Cardiopulmonary Physical Therapy Journal, 23(1), 5-13.

Garzon-Serrano, J., Ryan, C., Waak, K., Hirschberg, R., Tully, S., Bittner, E. A., Chipman, D. W., Schmidt, U., Kasotakis, G., Benjamin, J., Zafonte, R., & Eikermann, M. (2011). Early mobilization in critically ill patients: patients' mobilization level depends on health care provider's profession. PM&R, 3(4), 307-313. https://doi.org/10.1016/j.pmrj.2010.12.022

Hanekom, S., Gosselink, R., Dean, E., van Aswegen, H., Roos, R., Ambrosino, N., & Louw, Q. (2011). The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice. Clinical Rehabilitation, 25(9), 771-787. https://doi.org/10.1177/0269215510397677

Barber, E. A., Everard, T., Holland, A. E., Tipping, C., Bradley, S. J., & Hodgson, C. L. (2015). Barriers and facilitators to early mobilisation in Intensive Care: A qualitative study. Australian Critical Care, 28(4), 177-182. https://doi.org/10.1016/j.aucc.2014.11.001

Teves, C. (2017). Improving Patient Outcomes: Early Mobilization of Intensive Care Patients. Honors College Theses, 26. http://scholarworks.umb.edu/honors_theses/26

Dubb, R., Nydahl, P., Hermes, C., Schwabbauer, N., Toonstra, A., Parker, A. M., Kaltwasser, A., & Needham, D. M. (2016). Barriers and Strategies for Early Mobilization of Patients in Intensive Care Units. Annals of the American Thoracic Society, 13(5), 724-730. https://doi.org/10.1513/AnnalsATS.201509-586CME

Sommers, J., Engelbert, R. H., Dettling-Ihnenfeldt, D., Gosselink, R., Spronk, P. E., Nollet, F., & van der Schaaf, M. (2015). Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clinical Rehabilitation, 29(11), 1051-1063. https://doi.org/10.1177/0269215514567156

Callahan, L. A., & Supinski, G. S. (2016). Early Mobilization in the ICU: Help or Hype?* Critical Care Medicine, 44(6), 1239-1240. https://doi.org/10.1097/CCM.0000000000001733

Freeman, R., & Maley, K. (2013). Mobilization of Intensive Care Cardiac Surgery Patients on Mechanical Circulatory Support. Critical Care Nursing Quarterly, 36(1), 73-88. https://doi.org/10.1097/CNQ.0b013e31827532c3

Floyd, S., Craig, S. W., Topley, D., & Tullmann, D. (2016). Evaluation of a Progressive Mobility Protocol in Postoperative Cardiothoracic Surgical Patients. Dimensions of Critical Care Nursing, 35(5), 277-282. https://doi.org/10.1097/DCC.0000000000000197

Vitomskyi, V. V., & Al-Hawamdeh, K. M. (2020). Rol respiratornoi fizychnoi terapii u vidnovnomu likuvanni patsiientiv pislia kardiokhirurhichnykh vtruchan [The Role of Respiratory Physical Therapy in the Rehabilitation of Patients after Cardiac Surgery]. Ukrainskyi zhurnal medytsyny, biolohii ta sportu, 5(4), 17-25. https://doi.org/10.26693/jmbs05.04.017 [in Ukrainian].

Vitomskiy, V., Kormiltsev, V., Hruzevych, I., Salnykova, S., Shevchuk, Yu., & Yakusheva, Yu. (2018). Features of the physical development of children with functionally single heart ventricle as a basis of the physical rehabilitation technology after a hemodynamic correction. Journal of Physical Education and Sport, 18(Suppl. 1), 421-424. https://doi.org/10.7752/jpes.2018.s159

Gama Lordello, G. G., Gonçalves Gama, G. G., Lago Rosier, G., Viana, P., Correia, L. C., & Fonteles Ritt, L. E. (2020). Effects of cycle ergometer use in early mobilization following cardiac surgery: a randomized controlled trial. Clinical Rehabilitation, 34(4), 450-459. https://doi.org/10.1177/0269215520901763

Vitomskyi, V. (2020). The impact of mobilization and other factors on pleural effusion in patients undergoing cardiac surgical procedures. Journal of Physical Education and Sport, 20(Suppl. 3), 2167-2173. https://doi.org/10.7752/jpes.2020.s3291

Vitomskyi, V. V. (2020). Theoretical model of sternum external fixation functioning in physical therapy of patients following cardiac surgery via sternotomy. Art of Medicine, (3), 203-209. https://doi.org/10.21802/artm.2020.3.15.203

Bourdin, G., Barbier, J., Burlem, J.-F., Durante, G., Passant, S., Vincent, B., Badet, M., Bayle, F., Richard, J.-C., & Guérin, C. (2010). The Feasibility of Early Physical Activity in Intensive Care Unit Patients: A Prospective Observational One-Center Study. Respiratory Care, 55(4), 400-407. http://rc.rcjournal.com/content/55/4/400.short

Nakamura, K., Nakamura, E., Niina, K., & Kojima, K. (2010). Outcome after valve surgery in octogenarians and efficacy of early mobilization with early cardiac rehabilitation. General Thoracic and Cardiovascular Surgery, 58(12), 606-611. https://doi.org/10.1007/s11748-010-0665-0

Vollman, K. M. (2013). Understanding Critically Ill Patients Hemodynamic Response to Mobilization: Using the Evidence to Make It Safe and Feasible. Critical Care Nursing Quarterly, 36(1), 17-27. https://doi.org/10.1097/CNQ.0b013e3182750767

Santos, P. M. R., Ricci, N. A., Suster, É. A. B., Paisani, D. M., & Chiavegato, L. D. (2017). Effects of early mobilisation in patients after cardiac surgery: a systematic review. Physiotherapy, 103(1), 1-12. https://doi.org/10.1016/j.physio.2016.08.003

Castelino, T., Fiore, J. F., Jr, Niculiseanu, P., Landry, T., Augustin, B., & Feldman, L. S. (2016). The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review. Surgery, 159(4), 991-1003. https://doi.org/10.1016/j.surg.2015.11.029

Yayla, A., & Özer, N. (2019). Effects of early mobilization protocol performed after cardiac surgery on patient care outcomes. International Journal of Nursing Practice, 25(6), Article e12784. https://doi.org/10.1111/ijn.12784

Brown, J. K., Singh, K., Dumitru, R., Chan, E., & Kim, M. P. (2018). The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery. Methodist Debakey Cardiovascular Journal, 14(2), 77-88. https://doi.org/10.14797/mdcj-14-2-77

Fleming, I. O., Garratt, C., Guha, R., Desai, J., Chaubey, S., Wang, Y., Leonard, S., & Kunst, G. (2016). Aggregation of Marginal Gains in Cardiac Surgery: Feasibility of a Perioperative Care Bundle for Enhanced Recovery in Cardiac Surgical Patients. Journal of Cardiothoracic and Vascular Anesthesia, 30(3), 665-670. https://doi.org/10.1053/j.jvca.2016.01.017

Moreno, A. M., Castro, R. R., Sorares, P. P., Sant' Anna, M., Cravo, S. L., & Nóbrega, A. C. (2011). Longitudinal evaluation the pulmonary function of the pre and postoperative periods in the coronary artery bypass graft surgery of patients treated with a physiotherapy protocol. Journal of Cardiothoracic Surgery, 6, Article 62. https://doi.org/10.1186/1749-8090-6-62

Urell, C., Emtner, M., Hedenstrom, H., & Westerdahl, E. (2016). Respiratory muscle strength is not decreased in patients undergoing cardiac surgery. Journal of Cardiothoracic Surgery, 11, 41. https://doi.org/10.1186/s13019-016-0433-z

Westerdahl, E., Lindmark, B., Almgren, S. O., & Tenling, A. (2001). Chest physiotherapy after coronary artery bypass graft surgery - a comparison of three different deep breathing techniques. Journal of Rehabilitation Medicine, 33(2), 79-84. https://doi.org/10.1080/165019701750098920

Crowe, J. M., & Bradley, C. A. (1997). The Effectiveness of Incentive Spirometry With Physical Therapy for High-Risk Patients After Coronary Artery Bypass Surgery. Physical Therapy, 77(3), 260-268. https://doi.org/10.1093/ptj/77.3.260

Moradian, S. T., Najafloo, M., Mahmoudi, H., & Ghiasi, M. S. (2017). Early mobilization reduces the atelectasis and pleural effusion in patients undergoing coronary artery bypass graft surgery: A randomized clinical trial. Journal of Vascular Nursing, 35(3), 141-145. https://doi.org/10.1016/j.jvn.2017.02.001

Westerdahl, E., & Möller, M. (2010). Physiotherapy-supervised mobilization and exercise following cardiac surgery: a national questionnaire survey in Sweden. Journal of Cardiothoracic Surgery, 5, Article 67. https://doi.org/10.1186/1749-8090-5-67

Cheng, D. C. (1998). Fast-track cardiac surgery: economic implications in postoperative care. Journal of Cardiothoracic and Vascular Anesthesia, 12(1), 72-79. https://doi.org/10.1016/s1053-0770(98)90061-1

Downloads

Published

2021-04-16

How to Cite

1.
Vitomskyi VV, Lazarieva OB, Doroshenko EY, Vitomskа MV, Kovalenko TМ, Hertsyk AМ, Gavreliuk SV. The impact of mobilization protocols on the length of postoperative hospitalization among cardiac surgery patients. Zaporozhye Medical Journal [Internet]. 2021Apr.16 [cited 2024Jun.18];23(2):259-65. Available from: http://zmj.zsmu.edu.ua/article/view/228781

Issue

Section

Original research