Rehabilitation in the Cardiac Surgery Intensive Care Unit

Critical illness can be iatrogenic, arising from the lifesaving measures undertaken during admission to critical care. Early mobilization (EM) of patients receiving intensive care unit (ICU)-level care may reduce the possible iatrogenic effects of critical care following cardiac surgery. While evidence supports the safety and efficacy of physiotherapy in the medical-surgical ICU, few studies have included critically ill patients with complicated, prolonged post-operative recoveries despite the worldwide frequency of cardiac surgery. This has resulted in a lack of clinical practice guidelines or systematic reviews to help guide critical care physiotherapy practice in post-operative cardiac surgery. In-bed cycling is a modality to initiate EM. However, its safety and feasibility have yet to be established in the critically ill cardiac surgery population. There is also a paucity of qualitative research investigating clinicians’ attitudes and beliefs about in-bed cycling as an acceptable rehabilitation modality. Purposes: (1) To describe current physiotherapy practice for critically ill adult patients requiring prolonged admissions to ICU post cardiac surgery in Ontario via an electronic, self-administered survey; (2) To investigate the feasibility of in-bed cycling in a pilot study in a sample of critically ill cardiac surgery patients in Hamilton, Ontario; (3) To explore primary frontline clinicians’ experiences and impressions of their involvement with in-bed cycling in the cardiac surgical ICU via an interpretive description qualitative interview study. With adequate physiotherapy staffing, in-bed cycling was found to be safe and feasible with few adverse events occurring during cycling. With an 80% response rate, our survey results suggest that Ontario critical care physiotherapists provide a variety of interventions ranging from chest physiotherapy to functional mobility. Clinicians supported the use of in-bed cycling. Concerns included how to identify appropriate patients and timing of the intervention. This thesis built upon the current critical care research by increasing the presence of the cardiac surgery population in the rehabilitation literature.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.