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.

中文翻译：

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心脏手术后重症监护室物理治疗期间的生理异常和不良事件：一项前瞻性观察研究

背景

心脏手术后，重症监护病房（ICU）的患者在物理治疗期间可能会出现生理异常或不良事件。识别这些事件可能有助于改善患者的安全和护理。

目标

评估心脏手术后在 ICU 提供的物理治疗干预期间生理异常或不良事件的发生率和严重程度。探讨这些事件与患者特征和临床结果之间的关系。

方法

参考大学医院ICU收治心脏手术后成年患者的前瞻性观察研究。物理治疗干预由经过培训的团队观察，以评估和记录生理异常或不良事件的发生并对其后果进行分级。我们比较了有这些事件与没有这些事件的患者的基线特征和结果。

结果

我们在 323 名患者中观察了 935 次物理治疗干预，其中 189 次（20%，95% 置信区间：18, 23%）导致生理异常或不良事件。在气管内吸引 (44%)、步行 (40%) 和无创通气 (37%) 期间观察到这些事件的发生率最高。血流动力学变化是最常见的事件，占所有事件的 74%。只有 2% 的干预措施造成轻度伤害，0.2% 造成中度伤害。合并症的存在 与这些事件的发生相关 ( p = 0.03)。

结论

心脏手术后 ICU 患者的物理治疗干预中有 20% 发生了生理异常或不良事件，其中 10% 导致了负面影响。只有合并症的存在与这些事件的发生有关。