title: Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study.
abstract: BACKGROUND
  Active mobilization is a key component in fast-track surgical strategies. Following major surgery, clinicians are often reluctant to mobilize patients arguing that circulatory homeostasis would be impaired as a result of myocardial stunning, fluid shift, and autonomic dysfunction.
  
  
  OBJECTIVE
  We examined the feasibility and safety of a mobilization protocol 12-24 h after elective cardiac surgery.
  
  
  METHODS
  This observational study was performed in a tertiary nonacademic cardiovascular Intensive Care Unit.
  
  
  METHODS
  Over a 6-month period, we prospectively evaluated the hemodynamic response to a two-staged mobilization procedure in 53 consecutive patients. Before, during, and after the mobilization, hemodynamics parameters were recorded, including the central venous oxygen saturation (ScvO 2 ), lactate concentrations, mean arterial pressure (MAP), heart rate (HR), right atrial pressure (RAP), and arterial oxygen saturation (SpO 2 ). Any adverse events were documented.
  
  
  RESULTS
  All patients successfully completed the mobilization procedure. Compared with the supine position, mobilization induced significant increases in arterial lactate (34.6% [31.6%, 47.6%], P = 0.0022) along with reduction in RAP (-33% [-21%, -45%], P < 0.0001) and ScvO 2 (-7.4% [-5.9%, -9.9%], P = 0.0002), whereas HR and SpO 2 were unchanged. Eighteen patients (34%) presented a decrease in MAP > 10% and nine of them (17%) required treatment. Hypotensive patients experienced a greater decrease in ScvO 2 (-18 ± 5% vs. -9 ± 4%, P = 0.004) with similar changes in RAP and HR. All hemodynamic parameters, but arterial lactate, recovered baseline values after resuming the horizontal position.
  
  
  CONCLUSIONS
  Early mobilization after cardiac surgery appears to be a safe procedure as far as it is performed under close hemodynamic and clinical monitoring in an intensive care setting.
authors.affiliation: Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, 6900 Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Cassina
authors.affiliation: Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, 6900 Lugano, Switzerland.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Putzu
authors.affiliation: Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, 6900 Lugano, Switzerland.
authors.forename: Luisa
authors.initials: L
authors.lastname: Santambrogio
authors.affiliation: Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino Foundation, 6900 Lugano, Switzerland.
authors.forename: Michele
authors.initials: M
authors.lastname: Villa
authors.affiliation: Department of Anesthesiology, Pharmacology and Intensive Care, Faculty of Medicine, University Hospital of Geneva, 1206 Geneva, Switzerland.
authors.forename: Marc Joseph
authors.initials: MJ
authors.lastname: Licker
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D004434:Early Ambulation / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies