|
The Effect of Phase I Cardiac Rehabilitation on the Rate of Delirium After Coronary Artery Bypass Graft Surgery
|
Kolsoum Parnan Emamverdi1   , Zahra Sadat Manzari2 , Seyed Reza Mazloum3 |
1- mashhad university of medical sciences & Master in Nursing, Nursing and Midwifery School. Mashhad University of Medical Sciences, Mashhad, Iran
2- mashhad university of medical sciences & Associate Professor, Nursing and Midwifery care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. , manzariz@mums.ac.ir
3- mashhad university of medical sciences & Instructor, Nursing and Midwifery care Research Center, Mashhad University of Medical Sciences,Mashhad, Iran |
|
|
Abstract: (889 Views) |
Background and Aim: One of the known causes of delirium is hypoxia. Phase one cardiac rehabilitation program can improve pulmonary aerobic capacity and subsequently increase brain tissue perfusion. As a result, due to its hypoxia-reducing effects, it may be able to reduce delirium levels. The aim of this study was to determine the effect of phase one cardiac rehabilitation on the delirium level of patients after coronary artery bypass graft surgery.
Materials and Methods: This clinical trial study was performed on 60 patients in the cardiac intensive care unit of Imam Reza Hospital in Mashhad during 1398. After randomly assigning patients to two intervention and control groups, in patients in the intervention group, phase one of cardiac rehabilitation was performed. Patients in the control group received routine ward program. Delirium was measured by Nicham questionnaire in seven rounds, SPSS software version 20 was performed for analyzing data. Data were analyzed using Chi-square, independent t-test, Mann-Whitney and analysis of variance statistical tests. Pvalues less than 0.05 was considered as statistically significant.
Results:Two groups were homogeneous in terms of contextual variables. Results of analysis variance with repeated measurement test showed a significant difference between two groups in terms of delirium. (P= 0.016) The difference between two groups on the first to fourth days was significant and daily delirium levels of two groups on different days were significantly different from each other.(P= 0/001). p
Conclusion: This study showed performing phase one cardiac rehabilitation effectively reduces delirium. Therefore, phase one rehabilitation can be used as an affordable and low-cost approach to prevent and reduce delirium.
|
|
| Keywords: Delirium, patient, surgery, cardiac rehabilitation, Coronary Artery Bypass Graft |
|
|
Full-Text [PDF 779 kb]
(225 Downloads)
|
Type of Study: Original Research |
Subject:
Nursing
Received: 2022/03/13 | Accepted: 2023/03/6 | Published: 2024/12/29
|
|
|
|
|
|
|
| References |
1. Wu NN, Zhang YB, Wang SY, Zhao YH, Zhong XM. Incidence, prevalence and risk factors of delirium in ICU patients: A systematic review and meta‐analysis. Nurs. Crit. Care2023 ;28(5):653-69. [ DOI:10.1111/nicc.12857] 2. Stollings JL, Kotfis K, Chanques G, Pun BT, Pandharipande PP, Ely EW. Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Med. 2021;47(10):1089-1103. [ DOI:10.1007/s00134-021-06503-1] [ PMID] [ ] 3. Chen H, Mo L, Hu H, Ou Y, Luo J. Risk factors of postoperative delirium after cardiac surgery: a meta-analysis. J Cardiothorac Surg. 2021;16(1):1-11. [ DOI:10.1186/s13019-021-01496-w] [ PMID] [ ] 4. Mattison MLP. Delirium. Ann Intern Med. 2020;173(7):ITC49-ITC64. [ DOI:10.7326/AITC202010060] [ PMID] 5. Duning T, Ilting-Reuke K, Beckhuis M, Oswald D. Postoperative delirium - treatment and prevention. Curr Opin Anaesthesiol. 2021;1;34(1):27-32. [ DOI:10.1097/ACO.0000000000000939] [ PMID] 6. Shim JJ, Leung JM. An update on delirium in the postoperative setting: prevention, diagnosis and management. Best Pract Res Clin Anaesthesiol. 2012; 26(3):327-4 . [ DOI:10.1016/j.bpa.2012.08.003] [ PMID] 7. Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management Br J Anaesth. 2020;125(4):492-504. [ DOI:10.1016/j.bja.2020.06.063] [ PMID] 8. Yokota H, Ogawa S, Kurokawa A, Yamamoto Y. Regional cerebral blood flow in delirium patients. Psychiatr Clin Neurosci. 2003;57(3):337-9. [ DOI:10.1046/j.1440-1819.2003.01126.x] [ PMID] 9. Dominici C, Salsano A, Nenna A, Spadaccio C, El-Dean Z, Bashir M, et al. Neurological outcomes after on-pump vs off-pump CABG in patients with cerebrovascular disease. J Card Surg. 2019;34(10):941-47. [ DOI:10.1111/jocs.14158] [ PMID] 10. Miyazaki S, Yoshitani K, Miura N, Irie T, Inatomi Y, Ohnishi Y, et al. Risk factors of stroke and delirium after off-pump coronary artery bypass surgery. Interact Cardiovasc Thorac Surg. 2011;12(3):379-83. [ DOI:10.1510/icvts.2010.248872] [ PMID] 11. Kim C, Kim DY, Lee DW. The impact of early regular cardiac rehabilitation program on myocardial -function after acute myocardial infarction. Ann Rehabil Med. 2011;35(4):535-40.
https://doi.org/10.5535/arm.2015.39.4.535 [ DOI:10.5535/arm.2011.35.4.535] 12. Delaney A, Hammond N, Litton E. Preventing delirium in the intensive care unit. Jama. 2018;319(7):659-60. [ DOI:10.1001/jama.2018.0159] [ PMID] 13. Lim L, Nam K, Lee S, Cho YJ, Yeom CW, Jung S, et al. The relationship between intraoperative cerebral oximetry and postoperative delirium in patients undergoing off-pump coronary artery bypass graft surgery: a retrospective study. BMC Anesthesiol. 2020;20(1):1-10. [ DOI:10.1186/s12871-020-01180-x] [ PMID] [ ] 14. Gravante F, Giannarelli D, Pucci A, Gagliardi AM, Mitello L, Montagna A, et al. Prevalence and risk factors of delirium in the intensive care unit: an observational study. Nursing in critical care. 2021;26(3):156-65. [ DOI:10.1111/nicc.12526] [ PMID] 15. Krahne D, Heymann A, Spies C. How to monitor delirium in the ICU and why it is important. Clin Effectiveness Nurs. 2006; 10: 1016-27. [ DOI:10.1016/j.cein.2006.09.005] 16. Pieri M, De Simone A, Rose S, De Domenico P, Lembo R, Denaro G, et al. Trials Focusing on Prevention and Treatment of Delirium After Cardiac Surgery: A systematic Review of Randomized Evidence. J Cardiothorac Vasc Anesth. 2020; 34(6):1641-1654. [ DOI:10.1053/j.jvca.2019.09.028] [ PMID] 17. Shen YZ, Peng K, Zhang J, Meng X-W, Ji F-H. Effects of Haloperidol on Delirium in Adult Patients: A Systematic Review and Meta-Analysis. Med Princ Pract.2018. 27(3):250-59. [ DOI:10.1159/000488243] [ PMID] [ ] 18. Murri MB, Ekkekakis P, Menchetti M, Neviani F, Trevisani F, Tedeschi S, et al. Physical exercise for late-life depression: Effects on symptom dimensions and time course. J Affect Disord. 2018 ;230:65-70. [ DOI:10.1016/j.jad.2018.01.004] [ PMID] 19. Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2021;11. Available from:
https://doi.org/10.1002/14651858.CD001800.pub4 [ DOI:10.1002/14651858.CD001800.pub4,doi: 10.1002/14651858.CD001800.pub4] [ PMID] [ ] 20. Hshieh TT, Yue J, Oh E, Puelle M, Dowal S, Travison T, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA internal medicine. 2015;175(4):512-20 [ DOI:10.1001/jamainternmed.2014.7779] [ PMID] [ ] 21. Faustino TN, Suzart NA, dos Santos Rabelo RN, Santos JL, Batista GS, de Freitas YS, et al. Effectiveness of combined non-pharmacological interventions in the prevention of delirium in critically ill patients: A randomized clinical trial. J Crit Care. 2022;68:114-20 [ DOI:10.1016/j.jcrc.2021.12.015] [ PMID] 22. Falahinia GH , Tayebi Arasteh F , Mohamadi Y, Molavi Vardanjani M. Effect of eye mask and ear plug on level of agitation and incidence of delirium in ICU admitted patients. J Crit Care Nurs. 2020;12(4) :10-18. 23. Evans AS, Weiner MM, Arora RC, Chung I, Deshpande R, Varghese R, et al. Current approachto diagnosis and treatment of delirium after cardiac surgery. Ann Card Anaesth 2016;19(2):328-33. [ DOI:10.4103/0971-9784.179634] [ PMID] [ ] 24. Origuchi H, Itoh H, Momomura SI, Nohara R, Daida H, Masuda T, Kohzuki M, Makita S, Ueshima K, Nagayama M, Omiya K. Active participation in outpatient cardiac rehabilitation is associated with better prognosis after coronary artery bypass graft surgery-J-REHAB CABG study-. Circ J. 2020;84(3):427-35. [ DOI:10.1253/circj.CJ-19-0650] [ PMID] 25. Tian Y, Deng P, Li B, Wang J, Li J, Huang Y, Zheng Y. Treatment models of cardiac rehabilitation in patients with coronary heart disease and related factors affecting patient compliance. Rev Cardiovasc Med. 2019;20(1):27-33. [ DOI:10.31083/j.rcm.2019.01.53] [ PMID] 26. Dong Z, Yu B, Zhang Q, Pei H, Xing J, Fang W, et al. Early rehabilitation therapy is beneficial for patients with prolonged mechanical ventilation after coronary artery bypass surgery. Int Heart J. 2016;57(2):241-6. [ DOI:10.1536/ihj.15-316] [ PMID] 27. Lei L, Katznelson R, Fedorko L, Carroll J, Poonawala H, Machina M, et al. Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial. Anaesthesia. 2017;72(12):1456-66. [ DOI:10.1111/anae.14056] [ PMID] 28. Deiner S, Silverstein J. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009;103(suppl_1): 41-6 [ DOI:10.1093/bja/aep291] [ PMID] [ ] 29. Carlsson M, Berthelsen O, Fagevik Olsén M. Effects of a prolonged intervention of breathing exercises after cardiac surgery-a randomised controlled trial. European Journal of Physiotherapy. 2019;21(4):233-9. [ DOI:10.1080/21679169.2018.1531923] 30. Ghalmaghash R, Goushe B, Keyhani M, Bazrafshan A, Barzegari M, Hosseini A. The importance of First phase in cardiac rehabilitation and rate of implamantation in Tehran hospitals. Journal of Medical Concil of Islamic republic of Iran. 2006;24(2):123-32. 31. Neelon, V.J, Champagne, M.T, Carlson, J.R, Funk, S.G. The NEECHAM Confusion Scale: Construction, Validation, and Clinical Testing. Nursing Research,1996. 45(6):324-30. [ DOI:10.1097/00006199-199611000-00002] [ PMID] 32. Mariz J, Castanho T.C, Teixeira J, Sousa N, Santos N.C. Delirium Diagnostic and Screening Instruments in the Emergency Department: An Up-to-Date Systematic Review. Geriatrics. 2016; 1(3): 22. [ DOI:10.3390/geriatrics1030022] [ PMID] [ ] 33. Carvalho J.P.L.M, de Almeida A.R.P, Gusmao-Flores D. Delirium rating scales in critically ill patients: a systematic literature review. Rev Bras Ter Intensiva.2013;25(2):148-54. [ DOI:10.5935/0103-507X.20130026] [ PMID] [ ] 34. Esfahanian F, Mirmohammadsadeghi A, Gholami H, Neshat S, Mansouri M, Sadeghi M, et al. Using music for the prevention of delirium in patients after coronary artery bypass graft surgery: a randomized clinical trial. J Cardiothorac Vasc Anesth. 2022;36(12):4341-6 [ DOI:10.1053/j.jvca.2022.09.007] [ PMID] 35. Li X, Wang Y, Liu J, Xiong Y, Chen S, Han J, et al. Effects of perioperative interventions for preventing postoperative delirium: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine. 2021;100(29): e26662. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294881,doi: 10.1097/MD.0000000000026662 [ DOI:10.1097/MD.0000000000026662] [ PMID] [ ] 36. Borzou SR, Anoosheh M, Mohammadi E,Kazemnejad A. Exploring perception and experienceof patients from nursing care behaviors for providingcomfort during hemodialysis. J Qual Res Health Sci.2014;3(1):1-13. 37. Steinmetz C, Bjarnason-Wehrens B, Baumgarten H, Walther T, Mengden T, Walther C. Prehabilitation in patients awaiting elective coronary artery bypass graft surgery - effects on functional capacity and quality of life: a randomized controlled trial. Clin Rehabil. 2020;34(10):1256-67. [ DOI:10.1177/0269215520933950] [ PMID] [ ] 38. Ma L, Deng L, Yu H. The effects of a comprehensive rehabilitation and intensive education program on anxiety, depression, quality of life, and major adverse cardiac and cerebrovascular events in unprotected left main coronary artery disease patients who underwent coronary artery bypass grafting. Ir J Med Sci. 2020;189(2):477-88. [ DOI:10.1007/s11845-019-02129-x] [ PMID] 39. Mahmoodi z, hojjati zidashti z. Effect of four-week exercise therapy on pulmonary complications after coronary artery bypass surgery in patients with obstructive pulmonary disease. J Mazandaran Univ Med Sci. 2015;25(130):62-72. 40. Hojskov IE, Moons P, Egerod I, Olsen PS, Thygesen LC, Hansen NV, La Cour S, Bech KH, Borregaard B, Gluud C, Winkel P, Lindschou J, Kikkenborg Berg S. Early physical and psycho-educational rehabilitation in patients with coronary artery bypass grafting: A randomized controlled trial. J Rehabil Med. 2019;51(2):136-43. [ DOI:10.2340/16501977-2499] [ PMID] 41. Nydahl P, Gunther U, Diers A, Hesse S, Kerschensteiner C, Klarmann S, et al. Protocol-based mobilization on intensive care units: stepped-wedge, cluster-randomized pilot study (Pro-Motion). Nurs Crit Care. 2020;25(6):368-75. [ DOI:10.1111/nicc.12438] [ PMID] |
|
| Send email to the article author |
|
|
|
| Add your comments about this article |
|
|
|
|
Ethics code: IR.MUMS.REC.1398.156 Clinical trials code: RCT20191224045878N1
Parnan Emamverdi K, Manzari Z S, Mazloum S R. The Effect of Phase I Cardiac Rehabilitation on the Rate of Delirium After Coronary Artery Bypass Graft Surgery. SJKU 2024; 29 (5) :60-75 URL: http://sjku.muk.ac.ir/article-1-7277-en.html
|
