Comparison of the effect of implementation of three-phase and four-phase early mobilization protocol on clinical complication after CABG: a Randomized clinical trial study, single blind

Abstract

ABSTRACT

Introduction: Patients undergoing coronary artery bypass surgery after surgery due to long-term general anesthesia, wide sternal incision, involvement of vital organs of the heart and lungs during surgery, tracheal intubation and immobility that lead to pulmonary complications. They experience muscular and cognitive complications. Although evidence shows that early movement initiation can reduce postoperative complications in various patients and stabilize cognitive status, pain intensity, oxygenation levels, and pulmonary complications, so far in this field, the use of standard mobilization protocol early in this group of patients, there is no consensus. The purpose of this study is to compare the effect of two three-phase (based on pulmonary-respiratory physiotherapy exercises) and four-phase (based on ambulation -stretching exercises) early mobilization protocols on average arterial blood oxygen saturation, pulmonary complications, pain intensity, cognitive status and The length of stay in the hospital in patients undergoing coronary artery bypass surgery after surgery was aimed at achieving the best method in performing early movement in this group of patients. Methods: This study is a three-arm, single-blind clinical trial with the participation of 120 patients undergoing coronary artery bypass surgery. Four-phase intervention group; ambulation -stretching exercises (n=40), three-phase intervention group; lung exercises-breathing physiotherapy (n=40), control group; It was a routine hospital intervention (n=40). Inclusion criteria: stable hemodynamic status, absence of arrhythmia, no history of lung disease, chest tube drainage level was less than 100 cc in 4 hours. Eligible available samples were randomly assigned with a ratio of 1:1:1. The allocation sequence was generated by a person not involved in the research using RAS software and random block using three and six blocks for allocation in three groups. In this study, the statistical analyst and outcome examiner were only blinded. The study variables were measured on the first and second day after surgery in two shifts, morning and evening, while the patients were awake. After the first measurement, the intervention was performed and the pain intensity, Sao2, were measured immediately and 15 minutes after the intervention, and the cognitive status, pulmonary complications, ABG in the evening shift of the second day and the length of stay in the hospital on the day of discharge after the intervention. The tools used in the research were: Visual Analog Scale (Visual Scale of Pain) to evaluate pain, Mini Mental Examination (Cognitive Status Questionnaire) to check changes in cognitive status levels (which validity and reliability have been checked in different studies and in the section study tools have been mentioned) and values of Sao2 and Pao2 in arterial blood gases and chest x-ray examination obtained for the attention of the treating physician to evaluate the incidence of pulmonary complications and oxygen ion levels. The significance level for the statistical tests used was p<0.05. Results: The majority of participants in this study were female, 97±80.6, married, 2.99±119, illiterate, 66±53, self-employed, 37±3.08, smokers, 2.74±89, with previous heart attack history, 66± 3.57and the residents of the village 3.78±94. The results showed that performing the three- and four-phase protocol reduced the incidence of cognitive and pulmonary complications, the pain intensity, improved oxygenation levels, and reduced the length of hospital stay. Also, the analysis of the results using one-way ANOVA test showed that early mobilization with an emphasis on pulmonary exercises is more effective in reducing cognitive complications (P<0.001), improving oxygenation and reducing the incidence of pulmonary complications compared to the ambulation-stretching protocol (F< 0.001). Although the effect of performing early movement with emphasis on movement-stretching exercises was more in reducing pain compared to lung exercise protocol, the results were not significant (P=0.35). Comparing the results using the Tukey test, the use of the three-phase protocol compared to the control group significantly reduced the length of hospitalization in the study groups compared to the control group (P=0.01). Discussion and conclusion: The results of this study showed that each of the four and three-phase protocols compared to the control group in which the patients received routine care reduced pulmonary and cognitive complications, and this reduction effect was in the use group. Breathing exercises were more than the group of ambulation -stretching exercises. Early mobilization with more emphasis on pulmonary exercises and combined with motor exercises can be used as an auxiliary method by nurses in standard care of the intensive care unit to reduce clinical outcomes. It is recommended to conduct multicenter clinical trial studies with more participants in this field.