The effect of early mobilization of post-cardiac surgery patients on delirium: a pilot study

BACKGROUND: The best time to perform mobilization in patients after cardiac surgery is still unknown. Specifically, the efficacy and safety of initiating mobilization within the first 24 hours remain unclear. AIM: We evaluated the effect of early mobilization within 24 hours post cardiac surgery on the incidence of delirium. DESIGN: This was a single-centered randomized pilot study. SETTING: Tertiary teaching hospital. POPULATION: Adult post-cardiac surgery patients were randomized to early mobilization group or usual care group. METHODS: In the early mobilization group, sitting down with no support on a wheelchair for more than 30 minutes were implemented within 24 hours of intensive care unit (ICU) admission, then performed every day until day 7. In the usual care group, mobilization was performed after transferred to the cardiac surgery department, then performed every day until day 7. Screening for delirium by Confusion Assessment Method for the ICU (CAM-ICU) was performed on anesthesia recovery period, 8 hours after awakening, on the second day postsurgery, and every morning until 7 days. The primary outcome was the incidence of delirium during the first 7 days after randomization. The secondary outcomes included duration of delirium, mechanical ventilation time, length of ICU stay and in-hospital mortality. RESULTS: Sixty patients were enrolled, 30 assigned to each group. No baseline difference was identified between the early mobilization group and usual care group. The incidence of delirium was 26.7%. In the early mobilization group, a trend toward a lower incidence of delirium on the second day was found, and the duration of delirium was significantly shorter. No severe adverse events were identified during the first mobilization time, which lasted for almost 40 minutes. CONCLUSIONS: Early mobilization might be effective in reducing delirium incidence and duration for post-cardiac surgery patients, despite not significantly reducing its incidence. These preliminary findings should be tested in larger multicenter trials. CLINICAL REHABILITATION IMPACT: Early mobilization within 24 hours post-cardiac surgery might be effective in reducing delirium and is safe for post-cardiac surgery patients, which should be tested in larger multicenter trials.