Abstract
BackgroundDespite the unequivocal role of progressive mobilization in post-surgical patient management, its specific effects and timing, particularly after abdominal surgery, remain debated. This study’s aim was to examine the short-term effects of mobilization on oxygenation in hemodynamically stable patients after open surgery for pancreatic cancer.MethodsA randomized controlled clinical trial was conducted in which patients (n = 83) after open pancreatic surgery were randomized to either the same-day mobilization group (mobilized when hemodynamically stable within four hours after surgery) or the next-day mobilization group (mobilized first time in the morning of the first post-operative day). Mobilization was prescribed and modified based on hemodynamic and subjective responses with the goal of achieving maximal benefit with minimal risk. Blood gas samples were taken three times the evening after surgery; and before and after mobilization on the first post-operative day. Spirometry was conducted pre-operatively and on the first post-operative day. Adverse events and length of stay in postoperative intensive care were also recorded.ResultsWith three dropouts, 80 patients participated (40 per group). All patients in the same-day mobilization group, minimally sat over the edge of the bed on the day of surgery and all patients (both groups) minimally sat over the edge of the bed the day after surgery. Compared with patients in the next-day mobilization group, patients in the same-day mobilization group required lower FiO2 and had higher SaO2/FiO2 at 1800 h on the day of surgery (p < .05). On the day after surgery, FiO2, SaO2/FiO2, PaO2/FiO2, and alveolar-arterial oxygen gradient, before and after mobilization, were superior in the same-day mobilization group (p < 0.05). No differences were observed between groups in PCO2, pH, spirometry or length stay in postoperative intensive care.ConclusionsCompared with patients after open pancreatic surgery in the next-day mobilization group, those in the same-day mobilization group, once hemodynamically stable, improved oxygenation to a greater extent after mobilization. Our findings support prescribed progressive mobilization in patients after pancreatic surgery (when hemodynamically stable and titrated to their individual responses and safety considerations), on the same day of surgery to augment oxygenation, potentially helping to reduce complications and hasten functional recovery.Trial registration: This prospective RCT was carried out at the Sahlgrenska University Hospital, Sweden. The study was approved by the Regional Ethical Review Board in Gothenburg (Registration number: 437-17). Trial registration: “FoU in Sweden” (Research and Development in Sweden, URL: https://www.researchweb.org/is/vgr) id: 238701 Registered 13 December 2017 and Clinical Trials (URL:clinicaltrials.gov) NCT03466593. Registered 15 March 2018.
Highlights
Despite the unequivocal role of progressive mobilization in post-surgical patient management, its specific effects and timing, after abdominal surgery, remain debated
Over the past 20 years, interest has resurged with a call for further elucidation of the role of mobilization in acutely ill patients based on randomized controlled clinical trials (RCTs)
We examined the effect of initiation of mobilization as soon as the patient had stabilized after surgery, and systematically progressed patients through the steps of mobilization according to their responses and safety considerations
Summary
Despite the unequivocal role of progressive mobilization in post-surgical patient management, its specific effects and timing, after abdominal surgery, remain debated. Commensurate with the evolution of space science including microgravity-simulation bed-rest studies and exercise science, the multisystem effects of recumbency and inactivity were well documented several decades ago [1,2,3,4,5,6,7,8,9,10,11,12,13,14] Despite this unequivocal knowledge base, its translation to the mobilizing of acutely ill patients, those requiring high dependency care such as intensive and postoperative care, has lagged [15]. Mobilization is the term that has emerged in the literature that refers to patients being ‘upright and moving’ during hospitalization [16, 17] It subsumes a prescriptive and progressive series of steps in which patients move from recumbency to eventual walking with varying levels of assistance depending on the patient’s status and responses. Additional exercises can be prescribed at each step as part of the functional return continuum toward the patient’s achieving maximal and speedy recovery
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