Efficacy of Early Respiratory Physiotherapy and Mobilization After on-pump Cardiac Surgery: a Prospective Randomized Controlled Trial

Abstract

Objective: This randomized controlled trial aimed to investigate the influence of physical activity and respiratory physiotherapy on zero postoperative day on clinical, hemodynamic and respiratory parameters of patients undergoing cardiac surgeries under extracorporeal circulation.Methods: 78 patients undergoing coronary artery bypass graft (CABG) or/and valvular heart disease surgeries were randomly assigned into active physiotherapy group (APG; n=39) and conventional physiotherapy group (CPG; n=39). Treatment protocol for APG included ≤3 Mets of physical activity and respiratory physiotherapy on zero post-operative day and an extra physiotherapy session during the first three post-operative days, whereas CPG was treated with usual physiotherapy care after the first post-operative day. The length of hospital and intensive care unit (ICU) stay were set as the primary study outcomes, while pre- and post-intervention measurements were also performed to assess the oxymetric and hemodynamic influence of early mobilization and physiotherapy. Results: Participants’ mean age was 51.86 ±13.76 years. Of them 48 (61.5%) underwent CABG. Baseline and peri-procedural characteristics did not differ between the 2 groups. The total duration of hospital and ICU stay were significantly higher in the CPG compared to the APG (8.1±0.4 versus 10.2±0.6 days and 32.1±1.7 versus 23.2±0.6 hours, p<0.001, respectively). Statistically significant differences in pre-intervention oxygen saturation, and post-intervention PO2 and lactate levels were also observed between the 2 groups (p=0.022, 0.027 and 0.001, respectively). Conclusion: In on-pump cardiac surgery, early and active post-procedural physical activity (≤3 METS) can prevent prolonged ICU stay and decrease the duration of hospitalization whilst ameliorating post-operative hemodynamic and oxymetric parameters.