TY - JOUR T1 - Incidence of Orthostatic Hypotension during Early Postoperative Mobilization in Cardiac Surgery Patients TT - Kardiyak Cerrahi Uygulanan Hastalarda Erken Mobilizasyon Sırasında Ortostatik Hipotansiyon Görülme Sıklığı AU - Ay, Belma AU - Bulut, Hülya AU - Kurtoğlu, Murat PY - 2024 DA - December Y2 - 2024 JF - Genel Sağlık Bilimleri Dergisi JO - JGEHES PB - Necmettin Erbakan Üniversitesi WT - DergiPark SN - 2687-5403 SP - 491 EP - 503 VL - 6 IS - 3 LA - en AB - This study aimed to determine the incidence of orthostatic hypotension and orthostatic intolerance during early mobilization in patients who underwent coronary artery bypass graft surgery. The study was conducted as single group pre-experimental study. Patients who underwent coronary artery bypass graft surgery (n=108) in a private hospital and a university hospital in Ankara were included in the sample. Data were collected between May 2018 and February 2019. The data were collected using a Patient Diagnostic Form and Patient Mobilization Follow-Up Form developed by the researcher. Patients were mobilized according to the mobilization program developed by the researchers. The study is reported according to Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines. The sample consisted of 108 patients (72.2% male, mean age 64.67 ± 9.40 years). Postoperative mobilization was 19.23 ± 3.08 hours. According to preoperative data, 52 participants (48.1%) had orthostatic hypotension, and 47 participants (43.5%) had orthostatic intolerance. Participants often presented signs of intolerance (26.9%) in the second mobilization phase. There was no significant difference in the incidence of orthostatic intolerance between participants with and without orthostatic hypotension (p = 0.269). The results indicate that orthostatic hypotension and orthostatic intolerance are prevalent in patients after coronary artery bypass graft surgery. Healthcare professionals should diagnose orthostatic hypotension early with accurate hemodynamic measurements and monitoring of symptoms. KW - Cardiac Surgery KW - Early Mobilization KW - Intensive Care Unit KW - Orthostatic Hypotension N2 - Bu çalışmanın amacı, koroner arter bypass greft ameliyatı geçiren hastalarda erken mobilizasyon sırasında ortostatik hipotansiyon ve ortostatik intolerans görülme sıklığını belirlemektir. Araştırma tek gruplu deney öncesi araştırma tasarımı olarak yürütülmüştür. Çalışmanın örneklemini Ankara'da bir özel hastane ve bir üniversite hastanesinde koroner arter bypass greft ameliyatı geçiren hastalar (n=108) oluşturmaktadır. Veriler Mayıs 2018 ile Şubat 2019 tarihleri arasında toplanmıştır. Veriler araştırmacı tarafından geliştirilen Hasta Tanı Formu ve Hasta Mobilizasyon Takip Formu kullanılarak toplanmıştır. Hastalar araştırmacıların geliştirdiği mobilizasyon programına göre ameliyat sonrası mobilize edilmiştir. Çalışma Rastgele Olmayan Tasarımlarla Değerlendirmelerin Şeffaf Raporlanması kurallarına göre raporlanmıştır. Örneklem 108 hastadan (%72.2 erkek, ortalama yaş 64.67 ± 9.40 yıl) oluşmaktadır. Hastalar ameliyat sonrası 19.23 ± 3.08 saatte mobilize edilmiştir. Katılımcıların ameliyat öncesi ve mobilizasyon sırasındaki hemodinamik verileri karşılaştırıldığında 52 katılımcıda (%48.1) ortostatik hipotansiyon, 47 katılımcıda (%43.5) ortostatik intolerans saptanmıştır. Katılımcılarda sıklıkla mobilizasyonun ikinci aşamasında (%26.9) ortostatik intolerans belirtileri görülmüştür. Ortostatik hipotansiyonu olan ve olmayan katılımcılar arasında ortostatik intolerans insidansı açısından anlamlı bir fark saptanmamıştır (p = 0.269). Sonuç olarak, koroner arter bypass greft ameliyatı sonrası hastalarda ortostatik hipotansiyon ve ortostatik intolerans yaygın olarak görülmektedir. Sağlık çalışanları doğru hemodinamik ölçümler ve semptomların takibi ile ortostatik hipotansiyonu erken tanılamalıdır. CR - Brown, P. P., Kugelmass, A. D., Cohen, D. J., Reynolds, M. R., Culler, S. D., Dee, A. D., & Simon, A. W. (2008). The frequency and cost of complications associated with coronary artery bypass grafting surgery: Results from the United States Medicare program. The Annals of Thoracic Surgery, 85(6), 1980-1986. https://doi.org/10.1016/j.athoracsur.2008.01.053 CR - Bundgaard-Nielsen, M., Jørgensen, C. C., Jørgensen, T. B., Ruhnau, B., Secher, N. H., & Kehlet, H. (2009). Orthostatic intolerance and the cardiovascular response to early postoperative mobilization. British Journal of Anaesthesia, 102(6), 756-762. https://doi.org/10.1093/bja/aep083 CR - Cassina, T., Putzu, A., Santambrogio, L., Villa, M., & Licker, M. J. (2016). Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study. Annals of Cardiac Anaesthesia, 19(3), 425-432. https://doi.org/10.4103%2F0971-9784.185524 CR - Castelino, T., Fiore, J. F., Niculiseanu, P., Landry, T., Augustin, B., & Feldman, L. S. (2016). The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: a systematic review. Surgery, 159(4), 991-1003. https://doi.org/10.1016/j.surg.2015.11.029 CR - Feldstein, C., & Weder, A. B. (2012). Orthostatic hypotension: a common, serious and underrecognized problem in hospitalized patients. Journal of the American Society of Hypertension, 6(1), 27-39. https://doi.org/10.1016/j.jash.2011.08.008 CR - Jans, Ø., Brinth, L., Kehlet, H., & Mehlsen, J. (2015). Decreased heart rate variability responses during early postoperative mobilization–an observational study. BMC Anesthesiology, 15, 1-9. https://doi.org/10.1186/s12871-015-0099-4 CR - Jans, Ø., Bundgaard-Nielsen, M., Solgaard, S., Johansson, P. I., & Kehlet, H. (2012). Orthostatic intolerance during early mobilization after fast-track hip arthroplasty. British Journal of Anaesthesia, 108(3), 436-443. https://doi.org/10.1093/bja/aer403 CR - Kehlet, H., & Wilmore, D. W. (2008). Evidence-based surgical care and the evolution of fast-track surgery. Annals of Surgery, 248(2), 189-198. https://doi.org/10.1097/SLA.0b013e31817f2c1a CR - Lanier, J. B., Mote, M. B., & Clay, E. C. (2011). Evaluation and management of orthostatic hypotension. American Family Physician, 84(5), 527-536. https://www.aafp.org/pubs/afp/issues/2011/0901/p527.pdf CR - Leong, Y.L., Rasnah, A.R., & Chong, M.C. (2017). Patient early mobilization: A Malaysia’s study of nursing practices. Journal of Intensive and Critical Care, 3(3), 1-7. https://doi.org/10.21767/2471-8505.100088 Melnyk, M., Casey, R. G., Black, P., & Koupparis, A. J. (2011). Enhanced recovery after surgery (ERAS) protocols: Time to change practice?. Canadian Urological Association Journal, 5(5), 342-348. https://doi.org/10.5489%2Fcuaj.11002 CR - Müller, R. G., Bundgaard-Nielsen, M., & Kehlet, H. (2010). Orthostatic function and the cardiovascular response to early mobilization after breast cancer surgery. British Journal of Anaesthesia, 104(3), 298-304. https://doi.org/10.1093/bja/aep381 CR - Perme, C., & Chandrashekar, R. (2009). Early mobility and walking program for patients in intensive care units: creating a standard of care. American Journal of Critical Care, 18(3), 212-221. https://doi.org/10.4037/ajcc2009598 CR - Ricci, F., De Caterina, R., & Fedorowski, A. (2015). Orthostatic hypotension: epidemiology, prognosis, and treatment. Journal of the American College of Cardiology, 66(7), 848-860. http://dx.doi.org/10.1016/j.jacc.2015.06.1084 CR - Shroyer, A. L., Grover, F. L., Hattler, B., Collins, J. F., McDonald, G. O., Kozora, E., Lucke, J. C., Baltz, J. H., & Novitzky, D. (2009). On-pump versus off-pump coronary-artery bypass surgery. New England Journal of Medicine, 361(19), 1827-1837. https://doi.org/10.1056/NEJMoa0902905 CR - Stewart, J.M. (2013). Common syndromes of orthostatic intolerance. Pediatrics, 131(5), 968–980. https://doi.org/10.1542/peds.2012-2610 CR - Taito, S., Shime, N., Ota, K., & Yasuda, H. (2016). Early mobilization of mechanically ventilated patients in the intensive care unit. Journal of Intensive Care, 4, 1-7. https://doi.org/10.1186/s40560-016-0179-7 CR - Testa, G., Ceccofiglio, A., Mussi, C., Bellelli, G., Nicosia, F., Bo, M., Riccio, D., Curcio, F., Martone, A. M., Noro, G., Landi, F., Ungar, A., & Abete, P. (2018). Hypotensive drugs and syncope due to orthostatic hypotension in older adults with dementia (syncope and dementia study). Journal of the American Geriatrics Society, 66(8), 1532-1537. https://doi.org/10.1111/jgs.15421 UR - https://dergipark.org.tr/tr/pub/jgehes/issue//1398986 L1 - https://dergipark.org.tr/tr/download/article-file/3572812 ER -