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EPM.007
The safety of mobilisation on inotropes

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Background

It is well-recognised that patients who undergo cardiothoracic surgery are at a greater risk of pulmonary complications (Pasquina et al 2003).

There is a growing body of evidence to support early mobilisation as a key intervention for improving post-operative pulmonary function (Stiller et al 1994, Brasher et al 2003) and that early progressive activity in the intensive care (ITU) setting is both safe and feasible (Bailey et al 2007).

At Harefield Hospital early mobilisation is frequently used post-operatively to aid lung expansion, increase exercise tolerance and reduce the loss of muscle mass due to critical illness.

There is currently no published research regarding the safety of mobilisation on vasoactive agents in the rehabilitation of post-operative cardiothoracic patients.

Aims

We hypothesised that mobilising patients on vasoactive agents was safe and feasible, and aimed to record the incidence of significant haemodynamic changes and adverse events when patients mobilised on vasoactive agents as part of the physiotherapy treatment.

Method

Data were collected prospectively for all physiotherapy led treatments involving mobilising patients whilst receiving vasoactive agents. This included their cardiovascular and respiratory status, ventilatory support, level of inotropes and type of mobilisation.

Adverse physiological responses were also recorded; defined as either a +/-25% change in heart rate (HR) or +/-25% change in systolic blood pressure (BP).

Additionally other subjective or objective adverse incidents lasting more than 60 seconds were recorded, as set by a pre-defined list.

Results

A total of 51 audit forms were completed for 32 patients over a four month period.

Median age was 57 years (42 – 71) (25%- 75% IQR).

69% of patients were male.

75% of episodes of mobilisation took place in level 3 areas i.e. ITU or Recovery.

Four (8%) adverse events were identified: three reductions in systolic blood pressure >25% (one non-symptomatic) and one subjective marker related to dizziness. All symptoms resolved within 5 minutes of the patients returning to bed.

92% of treatment episodes were completed according to plan

Recommendations for practice

Physiotherapists should consider mobilisation of patients on vasoactive agents following cardiothoracic surgery.

Conclusion

From these data, mobilisation on vasoactive agents is feasible and appears to be a safe means of providing post-operative rehabilitation in a cardiothoracic population.

There appears to be no relationship between type of surgery, cardiovascular or respiratory status, dose and number of vasoactive agents or type of mobilisation and the risk of an adverse event.



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