Mixed venous oxygen desaturation during early mobilization after coronary artery bypass surgery

Kirkeby‐Garstad, Idar; Sellevold, Olav F Münter; Stenseth, Roar; Skogvoll, Eirik

doi:10.1111/j.1399-6576.2005.00617.x

Cited by 22 publications

(27 citation statements)

References 15 publications

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“…These results are in agreement with the responses of this variable found in both healthy individuals and those undergoing cardiovascular surgery when participating in low to moderate-intensity exercises, revealing an increase in HR proportional to the increase in metabolic demand [6][7][8][9]19]. In the present study, there was an increase in SAP limited strictly to the 3 rd day of the postoperative period, which was also found in a study carried out by Kirkeby et al [6] demonstrating a late rise in systemic vascular resistance in the postoperative period, which also explains the lack of an increase in SAP values on the 4 th day of the postoperative period in the present study.…”

Section: Resultssupporting

confidence: 90%

“…However, inherent factors to the procedure, such as anesthesia, hypothermia, cardioplegia and peri-aortic sympathetic lesions, potentially lead to cardiovascular dysfunction in the postoperative period [1]. Specifically, modulation of the autonomic nervous system, producing an abnormal increase in heart rate (HR), myocardial oxygen consumption and blood pressure (BP), may augment the sensation of exertion during physical activities performed during the early phase of recovery [2][3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular behavior during rehabilitation after coronary artery bypass grafting

Botega¹,

Cipriano²,

Lima³

et al. 2010

Rev Bras Cir Cardiovasc

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Métodos: Um total de 14 pacientes (idade média: 55,4 ± 6,4 anos, 78,6% do sexo masculino) participaram do estudo, todos apresentavam diagnóstico prévio de insuficiência coronariana e indicação de cirurgia eletiva. O protocolo consistiu de um grupo de exercícios de baixo impacto (2-3 METs) para extremidade superior e inferior e exercícios de caminhada realizados no pré e pós-operatório (3 e 4 dias). As seguintes variáveis foram avaliadas em repouso e após o programa de exercício: frequência cardíaca (FC, bpm), pressão arterial sistólica (PAS, mmHg), pressão arterial diastólica (PAD, mmHg), pressão arterial média (MAP, mmHg), duplo produto (DPr, bpm/mmHg) e escala de Índice de Percepção de Esforço (IPE).Resultados: Houve aumento significativo da FC e DPr na análise individual (P <0,001), bem como na análise entre os dias de avaliação (P <0,001 para FC e P <0,05 para DPr), mas apenas atingindo valores máximos que foram < 30% do previsto. Além disso, ocorreu correlação negativa entre a escala IPE e SAP e MAP. Conclusão:Os exercícios propostos mostraram-se seguros com a mudança de variáveis fisiológicas fundamentais em todo o experimento abaixo do valor recomendado para a fase de hospitalização. Além disso, a escala percepção de esforço parece ter correlação com algumas variáveis hemodinâmicas e, portanto, pode ser uma ferramenta útil para este grupo de pacientes. Descritores: Exercício. Procedimentos cirúrgicos cardiovasculares. Descondicionamento cardiovascular.Abstract Objective: The aim of the present study was to assess the behavior of cardiovascular variables during an in-hospital cardiovascular rehabilitation program in patients following myocardial revascularization surgery.Methods: A total of 14 patients (mean age: 55.4 ± 6.4 years, 78.6% male) participated in the study, all of whom had a previous diagnosis of coronary insufficiency and indication for elective surgery. The protocol consisted of a group of low-impact (2-3 METs) upper/lower extremity and walking exercises performed both pre and post-operatively (3 rd and 4 th days). The following variables were evaluated at rest and following the exercise program: heart rate (HR, 528BOTEGA, FS ET AL -Cardiovascular behavior during rehabilitation after coronary artery bypass grafting Bras Cir Cardiovasc 2010; 25(4): 527-533 Rev

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Section: Resultssupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Cardiovascular behavior during rehabilitation after coronary artery bypass grafting

Botega¹,

Cipriano²,

Lima³

et al. 2010

Rev Bras Cir Cardiovasc

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show abstract

“…Chest drains were removed on day one, 2-3 h before the postoperative measurements. Details are previously described (6,7).…”

Section: Methodsmentioning

confidence: 99%

“…In previous studies we found that mixed venous oxygen saturation (Svo 2 ) was markedly reduced and that there was no compensatory increase in cardiac index (CI) during mobilization on the first and second days after cardiac surgery (6,7). Despite hemodynamic data indicating that myocardial function was postoperatively reduced, the Svo 2 was unchanged and CI was increased after surgery (8).…”

mentioning

confidence: 98%

The Marked Reduction in Mixed Venous Oxygen Saturation During Early Mobilization After Cardiac Surgery: The Effect of Posture or Exercise?

Kirkeby‐Garstad

Wisløff²,

Skogvoll³

et al. 2006

Anesthesia & Analgesia

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Early mobilization after cardiac surgery induces a marked reduction in mixed venous oxygen saturation (Svo2). Using pulmonary artery catheters and indirect calorimetry, we investigated the effects of exercise and postural change on cardiac index (CI) and Svo2 before and on the first morning after coronary artery bypass surgery. Sixteen patients with an ejection fraction >0.50 were studied at rest, during supine bicycle exercise, and during passive standing. Supine cycling at 30 W increased CI by 1.5 +/- 0.8 L x min(-1) x m(-2) before and 0.9 +/- 0.7 L x min(-1) x m(-2) after surgery (P < 0.05), whereas Svo2 was reduced from 80% +/- 4% at rest to 63 +/- 6% preoperatively (P < 0.05) and from 71% +/- 5% to 46% +/- 11% postoperatively (P < 0.05). Passive standing reduced CI by 0.8 +/- 0.5 L x min(-1) x m(-2) before and 0.3 +/- 0.4 L x min(-1) x m(-2) after surgery (P < 0.05). Svo2 was reduced from 79% +/- 5% to 64% +/- 7% preoperatively (P < 0.05) and from 72% +/- 6% to 60% +/- 6% postoperatively (P < 0.05). The exercise challenge revealed an altered cardiovascular response after surgery, causing a larger reduction in Svo2 for the same workload. Passive standing significantly reduced Svo2 both days, but this effect was less pronounced after surgery. The response to postural change and exercise was altered after surgery and may both contribute to the reduction in Svo2 during postoperative mobilization.

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“…After CABG, regardless of the preoperative ejection fraction, 16 patients can present with a marked reduction in mixed venous oxygen saturation, 17 which can be associated with the previously mentioned pulmonary alterations and may negatively influence patient tolerance to early postoperative exercise. Thus, applying noninvasive ventilation during exercise could promote respiratory muscle unloading, improve gas exchange, and reduce muscular fatigability.…”

mentioning

confidence: 99%

Continuous Positive Airway Pressure During Exercise Improves Walking Time in Patients Undergoing Inpatient Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery

Pantoni

Thommazo-Luporini

Mendes

et al. 2016

Journal of Cardiopulmonary Rehabilitation and Prevention

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Mixed venous oxygen desaturation during early mobilization after coronary artery bypass surgery

Abstract: Patients with CABG exhibit a marked desaturation during early postoperative mobilization. Preoperative ejection fraction did not affect S(v)O(2) during exercise. The clinical consequences and underlying mechanism require further investigation.

Cited by 22 publications

References 15 publications

Cardiovascular behavior during rehabilitation after coronary artery bypass grafting

Cardiovascular behavior during rehabilitation after coronary artery bypass grafting

The Marked Reduction in Mixed Venous Oxygen Saturation During Early Mobilization After Cardiac Surgery: The Effect of Posture or Exercise?

Continuous Positive Airway Pressure During Exercise Improves Walking Time in Patients Undergoing Inpatient Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery

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