The impact of mobilization and other factors on pleural effusion in patients undergoing cardiac surgical procedures

Abstract

Purpose: To determine the impact of implementing an extra early mobilization protocol and other factors on pleural effusion in patients undergoing cardiac surgical procedures. Design: retrospective analysis Setting: hospitalized care. Participants: In 2018–2019, adult patients with less than 24 h of artificial lung ventilation were included. The first group was treated according to early mobilization protocols (2018 patients); the second group was treated according to extra early mobilization protocols (2019 patients). Interventions: The major difference was that the resources of the patient mobilization team have expanded since 2019; namely, the team included a physical therapist, which made it possible to modify early mobilization (standing on the 2nd postoperative day (POD), activation with the help of medical staff, inspiratory muscle training) into extra early mobilization (standing on the 1st POD with the consent of an anaesthesiologist, exercises with a physical therapist, and inspiratory muscle training). Main Outcome Measures: pleural effusion (left and right sides – PEL and PER, respectively, in mm) according to ultrasound findings on the 7th postoperative day. Results: The study revealed no differences between extra early mobilization and early mobilization groups in terms of PEL (14(5;24) mm vs. 12.5(5;22) mm; p = 0.389), PER (5(0;17) mm vs. 5(0;15.25) mm; p = 0.498), or frequency of additional interventions for PE drainage (drainage removal delay, re-insertion, or thoracocentesis) (10.1% vs. 7.5%; p = 0.398). The correlation analysis revealed mostly absence, weak, and very weak relations to PE, including ejection fraction and Euroscore II. The PEL and PER values were statistically higher in the coronary artery bypass graft and coronary artery bypass graft+valve surgery groups compared to the valve surgery group. Conclusions: Extra early mobilization protocol implementation did not lead to a decrease in PE or the number of additional interventions for PE drainage.