Preconditioning With Repeated Hyperbaric Oxygen Induces Myocardial and Cerebral Protection in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Prospective, Randomized, Controlled Clinical Trial

Background. Moderate-to-severe pain is reported in up to 75% of the patients in the first 48 hours after cardiac surgery. Evidence suggests that distraction is an effective nursing intervention for controlling short-term and transient pain. Distraction can be achieved by various techniques, including progressive muscle relaxation, meditation, and rhythmic breathing (RB). The present research aimed at evaluating the impacts of RB on the severity of sternotomy pain after Coronary Artery Bypass Graft (CABG). Methods. This randomized, controlled clinical trial was conducted on 60 patients after CABG surgery at the open-heart surgery Intensive Care Unit (ICU) of Kowsar Hospital, affiliated to Semnan University of Medical Sciences in Semnan, Iran. The patients were selected through convenience sampling and randomly assigned to two groups, including (1) intervention or RB and (2) control groups. RB was performed in the intervention group every 12 hours (9 a.m. and 9 p.m.) for three consecutive days after the surgery. The control group received only routine care for pain control (opioid analgesics) with no additional interventions. The severity of pain was measured every day in both groups of patients before and after the interventions using the Visual Analog Scale (VAS). Results. The mean postintervention pain scores were significantly different from the mean preintervention scores in the intervention group ( p < 0.05). The changes in the mean pain score in the intervention group were also significantly different from the corresponding changes in the controls ( p < 0.05). Conclusion. Based on the results, the severity of pain after the intervention was significantly lower in the RB group compared to the control. RB was found to be an effective technique for reducing the patients’ pain and is therefore recommended as a post-CABG pain control technique. Iranian Registry of Clinical Trials: this trial is clinically registered with IRCT20120109008665N7, registered 3 September 2018.

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Prehabilitation in patients awaiting elective coronary artery bypass graft surgery – effects on functional capacity and quality of life: a randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215520933950 ◽

2020 ◽

Vol 34 (10) ◽

pp. 1256-1267

Author(s):

Carolin Steinmetz ◽

Birna Bjarnason-Wehrens ◽

Heike Baumgarten ◽

Thomas Walther ◽

Thomas Mengden ◽

...

Keyword(s):

Quality Of Life ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Functional Capacity ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Randomized Controlled

Objective: To determine the impact of an exercise-based prehabilitation (EBPrehab) program on pre- and postoperative exercise capacity, functional capacity (FC) and quality of life (QoL) in patients awaiting elective coronary artery bypass graft surgery (CABG). Design: A two-group randomized controlled trail. Setting: Ambulatory prehabilitation. Subjects: Overall 230 preoperative elective CABG-surgery patients were randomly assigned to an intervention (IG, n = 88; n = 27 withdrew after randomization) or control group (CG, n = 115). Intervention: IG: two-week EBPrehab including supervised aerobic exercise. CG: usual care. Main measures: At baseline (T1), one day before surgery (T2), at the beginning (T3) and at the end of cardiac rehabilitation (T4) the following measurements were performed: cardiopulmonary exercise test, six-minute walk test (6MWT), Timed-Up-and-Go Test (TUG) and QoL (MacNew questionnaire). Results: A total of 171 patients (IG, n = 81; CG, n = 90) completed the study. During EBPrehab no complications occurred. Preoperatively FC (6MWTIG: 443.0 ± 80.1 m to 493.5 ± 75.5 m, P = 0.003; TUGIG: 6.9 ± 2.0 s to 6.1 ± 1.8 s, P = 0.018) and QoL (IG: 5.1 ± 0.9 to 5.4 ± 0.9, P < 0.001) improved signiﬁcantly more in IG compared to CG. Similar effects were observed postoperatively in FC (6MWDIG: Δ-64.7 m, pT1–T3 = 0.013; Δ+47.2 m, pT1–T4 < 0.001; TUGIG: Δ+1.4 s, pT1–T3 = 0.003). Conclusions: A short-term EBPrehab is effective to improve perioperative FC and preoperative QoL in patients with stable coronary artery disease awaiting CABG-surgery. ID: NCT04111744 ( www.ClinicalTrials.gov ; Preoperative Exercise Training for Patients Undergoing Coronary Artery Bypass Graft Surgery- A Prospective Randomized Trial)

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