What is the clinical evidence from this study?

Study design: Observational. Population: Cardiac surgery (n=159). Intervention: Early mobilization vs. Non-mobilized (bedridden). Primary outcome: ICU length of stay (hours) (p=0.001).

October 9, 2021Open Access

Early mobilization is associated with decreased mechanical ventilation and ICU length of stay following cardiac surgery

Key Result

Early mobilization within 24 hours of ICU admission after cardiac surgery significantly reduced ICU length of stay compared to non-mobilized patients (24 vs 47 hours).

Study Design

Type

Observational (n=159)

Multicenter

Structured PICO

Does early mobilization reduce the duration of mechanical ventilation and ICU length of stay in patients following cardiac surgery?

Population

n=159 adult patients admitted to the Cardiac Surgery ICU within 24 hours of cardiac surgery and receiving mechanical ventilation. Median age 71, 65% male, single-center in Greece. Exclusions: severe obesity (BMI > 35kg/m2), open sternum, lobectomy, ECMO support, extensive peripheral thigh oedema, preexisting neuromuscular disease, and ICU readmission.

Intervention

Early mobilization consisting of active and passive limb mobilization, sitting in bed, and transferring from bed to chair, initiated during ICU stay (assessed on days 1, 3, 5, and 7).

Comparator

Non-mobilized (bedridden) patients receiving standard ICU care.

Outcome

Duration of mechanical ventilation (MV) support and ICU length of stay.

Early mobilization after cardiac surgery is associated with a significantly reduced duration of mechanical ventilation and shorter ICU length of stay.

Main Result

Absolute Event Rate: 24% vs 47%

p-value: p=0.001

Limitations

Small sample size for the observed effect size because most participants exited ICU shortly post-admission
Mobilization activities were recorded according to documented sessions, limiting real-time observation
Sedation, hemodynamic instability, and patient safety concerns constrained early mobilization
Observational design was not randomized and not designed to determine causal effects

Abstract

Background: Early mobilization of the Intensive Care Unit (ICU) patients improves muscle strength and functional capacity. It has been demonstrated that prevents Intensive Care Unit Acquired Weakness (ICUAW) and accelerates ICU discharge. However, data on mobilization early after cardiac surgery are inadequate. This study aimed to record early mobilization and investigates the association with ICU findings in cardiac surgery patients.Material and Methods: In this observational study, 165 patients after cardiac surgery were enrolled. Of these, 159 were assessed for early mobilization and mobilization status during ICU stay. Mobilization practices were recorded from 1st post ICU admission and every 48 h until 7th day. The duration of mechanical ventilation (MV) support, ICU length of stay and clinical outcome were recorded from medical records registration. Results: Early mobilization consisted of active and passive limb mobilization, sitting in bed and transferring from bed to chair. The proportion of patients mobilized, was 18% (n = 29/159) on day 1, 53% (n = 46/87) on day 3, 54% (n = 22/41) on day 5 and 62% (n = 15/24) on day 7. ICU length of stay was reduced for mobilized patients (n = 29) on day 1 compared to non-mobilized ones (24 ± 10 vs 47 ± 73 h respectively, P = 0.001). The duration of MV was shorter in mobilized patients on day 3 (n =46) compared to bedridden, (18 ± 9 vs 23 ± 30 h respectively, P = 0.01).Conclusions: Early mobilization after cardiac surgery was found to be low with a significant trend to increase over ICU stay. It is also associated with a reduced duration of MV and ICU length of stay.

Bookmark

View Full Paper