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Early postoperative 30 degrees lateral positioning after coronary artery surgery: influence on cardiac output

Early postoperative 30 degrees lateral positioning after coronary artery surgery: influence on cardiac output
Early postoperative 30 degrees lateral positioning after coronary artery surgery: influence on cardiac output
Early postoperative 30? lateral positioning after coronary artery surgery: influence
on cardiac output
Aims and objectives. We investigated whether: (i) Early postoperative lateral position
after coronary artery bypass surgery may have a negative influence on the
cardiac output and (ii) Whether turning procedures cause practical problems.
Background. Directly following surgery, coronary artery bypass patients are not
receiving routine turning every two hours to prevent pressure ulcers, because a
negative influence on hemodynamic parameters is assumed.
Design. Clinical trial.
Methods. Fifty-five coronary artery bypass patients were randomly assigned to four
intervention regimens and underwent a two-hour period of 30? lateral position.
Fourteen patients in supine position served as a reference group. We hypothesized
that 30? lateral position does not cause a relevant change in the cardiac output.
Results. Turning the patients did not have any significant influence on the cardiac
index, not even in the patients in a poor hemodynamic condition. The cardiac index
in 30? lateral position and supine position two to eight hours postoperatively after
coronary artery bypass surgery is statistically bioequivalent. No clinically relevant
deviations from preset ‘safe’ values for mean arterial pressure, right atrial pressure,
pulmonary artery wedge pressure and pulmonary arterial pressure were observed,
which would require ending the lateral position. There were no practical problems
hindering the turning regimen, not even in the patients with an intra-aortic balloon
pump.
Conclusions. Early postoperative turning of coronary artery bypass surgery patients
in lateral position is an easy and feasible procedure that does not influence the
cardiac index not even in patients receiving antihypertensive or inotropic/vasopressor
therapy. Further research is needed to find out whether our findings are also
valid in other patient groups and other position conditions.
Relevance to clinical practice. If there are no strict contra-indications, lateral
position has to be considered to prevent complications of continuous supine position
within two hours after coronary artery bypass surgery patients have been admitted
to the intensive care unit.
0962-1067
654-661
De Laat, E.
545481df-801d-4f0b-8ded-da080bc4c388
Schoonhoven, L.
46a2705b-c657-409b-b9da-329d5b1b02de
Grypdonck, M.
5aa8a13f-a444-4be2-bb5b-f170a7ffbaf4
Verbeek, A.
9b1ec2b9-0085-4eb5-9eb0-a4aa0ce82e49
de Graaf, R.
927caf67-c7fc-4065-8084-b62afe78d5f1
Pickkers, P.
8fa9ec7b-278d-4fd1-9f98-1dca3d54fbf4
van Achterberg, T.
1b413585-49b3-4989-a1b6-7fb4d4bac453
De Laat, E.
545481df-801d-4f0b-8ded-da080bc4c388
Schoonhoven, L.
46a2705b-c657-409b-b9da-329d5b1b02de
Grypdonck, M.
5aa8a13f-a444-4be2-bb5b-f170a7ffbaf4
Verbeek, A.
9b1ec2b9-0085-4eb5-9eb0-a4aa0ce82e49
de Graaf, R.
927caf67-c7fc-4065-8084-b62afe78d5f1
Pickkers, P.
8fa9ec7b-278d-4fd1-9f98-1dca3d54fbf4
van Achterberg, T.
1b413585-49b3-4989-a1b6-7fb4d4bac453

De Laat, E., Schoonhoven, L., Grypdonck, M., Verbeek, A., de Graaf, R., Pickkers, P. and van Achterberg, T. (2007) Early postoperative 30 degrees lateral positioning after coronary artery surgery: influence on cardiac output. Journal of Clinical Nursing, 16 (4), 654-661. (doi:10.1111/j.1365-2702.2006.01715.x). (PMID:17402946)

Record type: Article

Abstract

Early postoperative 30? lateral positioning after coronary artery surgery: influence
on cardiac output
Aims and objectives. We investigated whether: (i) Early postoperative lateral position
after coronary artery bypass surgery may have a negative influence on the
cardiac output and (ii) Whether turning procedures cause practical problems.
Background. Directly following surgery, coronary artery bypass patients are not
receiving routine turning every two hours to prevent pressure ulcers, because a
negative influence on hemodynamic parameters is assumed.
Design. Clinical trial.
Methods. Fifty-five coronary artery bypass patients were randomly assigned to four
intervention regimens and underwent a two-hour period of 30? lateral position.
Fourteen patients in supine position served as a reference group. We hypothesized
that 30? lateral position does not cause a relevant change in the cardiac output.
Results. Turning the patients did not have any significant influence on the cardiac
index, not even in the patients in a poor hemodynamic condition. The cardiac index
in 30? lateral position and supine position two to eight hours postoperatively after
coronary artery bypass surgery is statistically bioequivalent. No clinically relevant
deviations from preset ‘safe’ values for mean arterial pressure, right atrial pressure,
pulmonary artery wedge pressure and pulmonary arterial pressure were observed,
which would require ending the lateral position. There were no practical problems
hindering the turning regimen, not even in the patients with an intra-aortic balloon
pump.
Conclusions. Early postoperative turning of coronary artery bypass surgery patients
in lateral position is an easy and feasible procedure that does not influence the
cardiac index not even in patients receiving antihypertensive or inotropic/vasopressor
therapy. Further research is needed to find out whether our findings are also
valid in other patient groups and other position conditions.
Relevance to clinical practice. If there are no strict contra-indications, lateral
position has to be considered to prevent complications of continuous supine position
within two hours after coronary artery bypass surgery patients have been admitted
to the intensive care unit.

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Published date: April 2007
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 339729
URI: http://eprints.soton.ac.uk/id/eprint/339729
ISSN: 0962-1067
PURE UUID: e2752a7a-85d2-4d28-bd42-c8af7e7d5a0f
ORCID for L. Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 30 May 2012 09:12
Last modified: 17 Dec 2019 01:39

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