The Safe Early Mobilization on CABG

Hulya BULUT60 enrolled

Overview

Aim: This study aimed to evaluate the effect of a Safe Early Mobilization Protocol (SEMP) developed for patients undergoing coronary artery bypass graft (CABG) surgery on patient outcomes. Design: A single-center, parallel-group, randomized controlled trial. Methods: The study was conducted with 60 patients in 2023. The intervention group received a Safe Early Mobilization Protocol including bedside elevation, deep breathing and coughing exercises, sitting upright in bed, sitting on the edge of the bed, standing, ambulation, and sitting in a bedside chair from the day of surgery until the fourth postoperative day. The control group received routine mobilization care. Respiratory parameters, orthostatic hypotension (OH), orthostatic intolerance (OI), mobilization distance, anxiety level, and hospital stay were evaluated.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

Conditions

Coronary Artery Bypass Graft Nursing

Interventions

This protocol was developed to guide the early postoperative mobilization of patients undergoing coronary artery bypass graft surgery, covering the period from the day of surgery to the fourth postoperative day. Prior to mobilization, patients are evaluated using a checklist ensuring physical and environmental safety. On the day of surgery, following extubation by the responsible physician, six stages are applied: bed head elevation, deep breathing exercises, incentive spirometry, passive range of motion (ROM) exercises, sitting upright (90°), and sitting on the edge of the bed. On postoperative days 1-3, standing at the bedside, ambulation, and sitting on a chair are added. Target walking distances are 100-150 m on day 1, 200-250 m on day 2, and 300-350 m on day 3. Distances are measured by the researcher using a meter. The protocol concludes on the 4th postoperative day when the patient can ambulate independently.

Control GroupOTHER

Patients in the control group were informed about the current mobilization practices applied in the clinic before surgery. The morning after the surgery (the first day after the surgery), the patient is first seated in the bed, and in the second stage, he is made to sit on the edge of the bed with his feet touching the floor and is observed. In the third stage, the patient stands in an upright position and if there is no dizziness or blackout, the patient is seated on a chair next to the bed. The duration of sitting in the chair is determined depending on the general condition of the patient (pain, dizziness, blackout, nausea). On the 2nd and 3rd postoperative day, patients were contacted by nurses and care support staff while they had a chest tube; Then, the patient is mobilized only with his/her relative. There is no standard practice regarding how long patients should be mobilized during the day.

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: Hemodynamic stability, defined as: Resting heart rate \<110/min Mean arterial pressure between 60-110 mmHg Oxygen saturation (SpO₂) \>88% Receiving dopamine infusion ≤5 mcg/kg/min at the time of enrollment No auditory, speech, or visual impairments No neurological contraindications (e.g., cerebrovascular accident \[CVA\], ataxia, multiple sclerosis \[MS\]) No orthopedic contraindications that prevent mobilization (e.g., fractures or sequelae) Provided informed consent to participate in the study Age ≥18 years Able to speak Turkish Literate patients Exclusion Criteria: Requirement for intra-aortic balloon pump (IABP) support Postoperative cerebrovascular events High-dose inotropic drug infusion in the early postoperative period: Dopamine ≥10 mcg/kg/min Norepinephrine ≥0.5 mcg/kg/min Concurrent dopamine and norepinephrine infusion Severe arrhythmias preventing mobilization, including: Sinus tachycardia ≥120/min Rapid atrial fibrillation Ventricular tachycardia Ventricular fibrillation Advanced chronic obstructive pulmonary disease (COPD) or bronchiectasis Diagnosed anxiety disorders

Outcomes

Primary Outcomes

Number of Participants With Orthostatic Hypotension

Orthostatic hypotension defined as a ≥20 mmHg decrease in systolic BP and/or ≥10 mmHg decrease in diastolic BP.

Time frame: Daily postoperative measurements for up to 3 days.

Number of Participants With Orthostatic Intolerance

Orthostatic intolerance defined as the presence of dizziness, nausea, weakness, blurred vision, or syncope.considered as OI.

Time frame: Daily postoperative assessments for up to 3 days.

Oxygen Saturation Level (%)

Peripheral oxygen saturation (SpO₂) measured using pulse oximetry.

Time frame: Daily postoperative measurements for up to 3 days.

State Anxiety Scale Score

The State Anxiety Inventory (STAI-S) will be used (score range: 20-80; higher scores indicate worse anxiety).

Time frame: Postoperative day 1 and postoperative day 4.

Six-Minute Walk Test Distance (Meters)

Distance walked during the Six-Minute Walk Test (0-∞ meters; higher distance indicates better functional capacity).

Time frame: Postoperative day 4.

Secondary Outcomes

Length of Hospital Stay (Days)

Total duration of postoperative hospitalization, including ICU and ward stay.

Time frame: From postoperative day 0 until hospital discharge (up to 30 days).