Dataset Information

Physiological abnormalities and adverse events during physical therapy in the intensive care unit after cardiac surgery: A prospective observational study.

ABSTRACT:

Background

After cardiac surgery, physiological abnormalities or adverse events might occur in patients in the intensive care unit (ICU) during physical therapy care. Identifying these events may help improve patient safety and care.

Objectives

To estimate the incidence and the degree of severity of physiological abnormalities or adverse events during physical therapy interventions provided in the ICU after cardiac surgery. To explore the relationship between these events and patients' characteristics and clinical outcomes.

Methods

Prospective observational study of adult patients in the postoperative period of cardiac surgery admitted to the ICU of a referenced university hospital. Physical therapy interventions were observed by a team trained to evaluate and register the occurrence of physiological abnormalities or adverse events and grading their consequences. We compared baseline characteristics and outcomes of patients with versus without these events.

Results

We observed 935 physical therapy interventions in 323 patients, of which 189 (20%, 95% confidence interval: 18, 23%) resulted in physiological abnormalities or adverse events. The highest incidences of these events were observed during endotracheal suctioning (44%), walking (40%), and noninvasive ventilation (37%). Hemodynamic changes were the most frequent events accounting for 74% of all events. Only 2% of interventions resulted in mild harm and 0.2% in moderate harm. The presence of comorbidities was associated (p = 0.03) with the occurrence of these events.

Conclusion

Physiological abnormalities or adverse events occurred in 20% of physical therapy interventions in patients in the ICU after cardiac surgery, with 10% of those resulting in negative effects. Only the presence of comorbidities was associated with the occurrence of these events.

SUBMITTER: Sousa MLA

PROVIDER: S-EPMC8536846 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background: The postoperative period is critical for a patient's recovery, and postoperative hypotension, specifically, is associated with adverse clinical outcomes and significant harm to the patient. However, little is known about the association between postoperative hypotension in patients in the intensive care unit (ICU) after non-cardiac surgery, and morbidity and mortality, specifically among patients who did not experience intraoperative hypotension. The goal of this study was to assess the impact of postoperative hypotension at various absolute hemodynamic thresholds (??75,???65 and???55 mmHg), in the absence of intraoperative hypotension (??65 mmHg), on outcomes among patients in the ICU following non-cardiac surgery.Methods: This multi-center retrospective cohort study included specific patient procedures from Optum® healthcare database for patients without intraoperative hypotension (MAP???65 mmHg) discharged to the ICU for???48 h after non-cardiac surgery with valid mean arterial pressure (MAP) readings. A total of 3185 procedures were included in the final cohort, and the association between postoperative hypotension and the primary outcome, 30-day major adverse cardiac or cerebrovascular events, was assessed. Secondary outcomes examined included all-cause 30- and 90-day mortality, 30-day acute myocardial infarction, 30-day acute ischemic stroke, 7-day acute kidney injury stage II/III and 7-day continuous renal replacement therapy/dialysis.Results: Postoperative hypotension in the ICU was associated with an increased risk of 30-day major adverse cardiac or cerebrovascular events at MAP???65 mmHg (hazard ratio [HR] 1.52; 98.4% confidence interval [CI] 1.17-1.96) and???55 mmHg (HR 2.02, 98.4% CI 1.50-2.72). Mean arterial pressures of???65 mmHg and???55 mmHg were also associated with higher 30-day mortality (MAP???65 mmHg, [HR 1.56, 98.4% CI 1.22-2.00]; MAP???55 mmHg, [HR 1.97, 98.4% CI 1.48-2.60]) and 90-day mortality (MAP???65 mmHg, [HR 1.49, 98.4% CI 1.20-1.87]; MAP???55 mmHg, [HR 1.78, 98.4% CI 1.38-2.31]). Furthermore, we found an association between postoperative hypotension with MAP???55 mmHg and acute kidney injury stage II/III (HR 1.68, 98.4% CI 1.02-2.77). No associations were seen between postoperative hypotension and 30-day readmissions, 30-day acute myocardial infarction, 30-day acute ischemic stroke and 7-day continuous renal replacement therapy/dialysis for any MAP threshold.Conclusions: Postoperative hypotension in critical care patients with MAP???65 mmHg is associated with adverse events even without experiencing intraoperative hypotension.