American Journal of Nursing Research
ISSN (Print): 2378-5594 ISSN (Online): 2378-5586 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Nursing Research. 2019, 7(4), 490-498
DOI: 10.12691/ajnr-7-4-11
Open AccessArticle

The Effect of Early Ambulation on Hemodynamic and Perfusion Indices Post Cardiac Surgery

Hanaa Hussein Ahmed1,

1Critical Care and Emergency Nursing Department, Mansoura University, Egypt

Pub. Date: May 23, 2019

Cite this paper:
Hanaa Hussein Ahmed. The Effect of Early Ambulation on Hemodynamic and Perfusion Indices Post Cardiac Surgery. American Journal of Nursing Research. 2019; 7(4):490-498. doi: 10.12691/ajnr-7-4-11


Delayed mobilization of cardiac surgical patients (CSPs) postoperatively is a huge challenge for critical care nurses (CCNs). Early ambulation (EA) is a vital task with a significant priority of nursing practice in critical care units (ICUs). CCNs’ awareness of EA value for CSPs’ outcomes is the main concern. The inclusive aim of EA is to sustain hemodynamic stability and adequate organ perfusion. The current study aimed to examine the effect of EA on hemodynamic and perfusion indices post cardiac surgery. Sixty adult patients of both sexes undergoing cardiac surgery were involved in this study. Then they assigned randomly into two groups; EA group and hospital care (HC) group. Data were collected using one tool which encompasses three parts containing the patient preoperative basic health data, hemodynamic indices record and perfusion indices record. The findings presented that peripheral pulse (PP) and heart rates were decreased tenuously among the EA patients compared with HC patients. However, the systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were increased significantly in EA group than HC group post ambulation compared with preoperative readings. Additionally, perfusion indices were increased among the EA patients and HC patients post mobilization compared with preoperative readings. The current study showed that EA has better effect on the patients hemodynamic and perfusion indices postoperatively. Thus, CCNs should give a high priority to plan EA schedule when caring for CSPs. Furthermore, there is a need for EA algorithms in ICUs.

early ambulation hemodynamic indices perfusion indices cardiac surgery critical care nurse

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Tariq, M. I., Khan, A. A., Khalid, Z., Farheen, H., Siddiqi, F. A., & Amjad, I. Effect of early 3 mets (metabolic equivalent of tasks) of physical activity on patient's outcome after cardiac surgery. Journal of the College of Physicians and Surgeons Pakistan. 27(8): 490-494. 2017.
[2]  Brustia, P., Cassatella, R., Renghi, A., Gramaglia, L., Aronici, M., & Casella, F. Fast track pathways: early ambulation after open aortic surgery in elderly patients is not only safe but recommendable. Clin Surg. 2: 1407. 2018. http//
[3]  Herridge, M. S., Cheung, A. M., & Tansey, C. M. One year outcomes in survivors of acute respiratory distress syndrome. N Engl Med. 348: 683-693. 2003.
[4]  Morris, P. E. Moving our critically ill patients: mobility barriers and benefits. Crit Care Clin. 23: 1-20. 2007.
[5]  Dowdy, D. W., Eid, M. P., & Dennison, G. R. Quality of life after acute respiratory distress syndrome: A meta-analysis. Intensive Care Med. 32: 1115-1124. 2006.
[6]  Timmerman, R. A. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 26(5): 175-179. 2007.
[7]  Morton, P. G., & Fontaine, D. K. Critical care nursing: a holistic approach. (11th edition). Lippincott Williams & Wilikins Co., Philadelphia. 2018.
[8]  Farmanbar, R., Chinikar, M., Gozalian, M., Baghaie, M., Roshan, Z. A., & Moghadamnia, M. The effect of post coronary angiography bed-rest time on vascular complications. J Tehran Univ Heart Center. 3(4):225-8. 2008.
[9]  Ashktorab, T., Neishaboory, M., Piranfar, M. A., & Alavi-Majd, H. Effects of bed rest on reduction after coronary angiography on local vascular complications and back pain. Advanced in Nursing & Midwifery. 18 (63):30-38. 2009.
[10]  Anchala, A. M. A study to assess the effect of therapeutic positions on hemodynamic parameters among critically ill patients in the intensive care unit at Sri Ramachandra Medical Centre. J Nurs Care. 5(3):2-8. 2016.
[11]  Van-Laar, C., TImman, S. T., & Noyez, L. Decreased physical activity is a predictor for a complicated recovery post cardiac surgery. Health and Qual Life Outcomes. 15(5):2-7. 2017.
[12]  Shabani, R., Nikbakht, H., Nikoo, M. R., Cheragi, M., Hojatoleslami, S., Shirmohammadi, T., et al.. Effects of cardiac rehabilitation program on physical capacity, blood pressure, heart rate recovery and myocardial oxygen consumption in patients undergoing coronary artery bypass grafting. Med Sci J Islamic Azad Univ Tech Med Branch. 21(2):108-113. 2011.
[13]  Medrinal, C., Combret , Y., Prieur, G., Quesada, A. R., Bonnevie, T., Gravier, F. E., et al. Effects of different early rehabilitation techniques on haemodynamic and metabolic parameters in sedated patients: protocol for a randomised, single-bind, cross-over trial. BMJ Open Resp Res. 3:e000173. 2016.
[14]  Bourdin, G., Barbier, J., Burle, J. F., Durante, G., Passant, S., Vincent, B., et al. The feasibility of early physical activity in intensive care unit patients: A prospective observational one center study. Respir Care. 55(4):400-407. 2010.
[15]  Şenduran, M., Genç, A., Akan, M., & Günerli, A. Effects of mobilization on hemodynamic and respiratory responses in critically ill patients. Fizyoter Rehabil. 23(1):3-9. 2012.
[16]  Senduran, M., Yurdalan, S. U., Karadibak, D., and Gunerli, A. Haemodynamic effects of physiotherapy programme in intensive care unit after liver transplantation. Disabil Rehabil. 32(17): 1461-1466. 2010.
[17]  Genc, A., Ozyurek, S., Koca, U., & Gunerli, A. Respiratory and hemodynamic responses to mobilization of the critically ill obese patients. Cardiopulmonary Physical Therapy Journal. 23(1): 14-18. 2012.
[18]  Cortes, O. L., Villar, J. C., Devereaux, P. J., and DiCenso, A. Early mobilization for patients following acute myocardiac infarction: a systematic review and meta-analysis of experimental studies. Int J Nurs Stud. 46(11): 1496-504. 2009.
[19]  Moghadam, M. Y., Aminnejad, R., Azarfarin, R., Alikhani, R., Ziyaeifard, M., Beh, F. G., et al. Effects of early mobilization protocol on cognitive outcome after cardiac surgery. Ann Anesth Crit Care. 2(3):e63594. 2017.
[20]  Hodgson, C. L., Capell, E., & Tipping, C. J. Early mobilization of patients in intensive care: organization, communication and safety factors that influence translation into clinical practice. Critical Care. 22(77): 1-7. 2018.
[21]  Dafoe, S., Stiller, K., & Chapman, M. Staff perceptions of the barriers to mobilizing ICU patients. Internet Journal of Allied Health Sciences and Practice. 13(2): 1-13. 2015.
[22]  Cassina, T., Putzu, A., Santambrogio, L., Villa, M., & Licker, M. J. Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study. Annals of Cardiac Anaesthesia. 19(3): 425-432. 2016.
[23]  Asgari, M. R., Jafarpoor, H., Soleimani, M., Ghorbani, R., Askandarian, R., & Jafaripour, I. Effects of early mobilization program on the heart rate and blood pressure of patients with myocardial infarction hospitalized at the coronary care unit. Middle East J Rehabil Health. 2(1): e24168. 2015.
[24]  Kress, J. P. Clinical trials of early mobilization of critically ill patients. Crit Care Med. 37(10 s): S 442-7. 2009.
[25]  El-Sayed, H. Effect of early activity on occurrence of postoperative cardiovascular complications after cardiac surgery. Resuscitation. Poster presentation. 84(1) S61. 2013.
[26]  Ahmed, H. H., Ibrahim, Y. M., El Soussi, A. H., & Elsaid, M. M. The effect of early activity on patients’ outcome after open heart surgery. AJAIC. 9(3): 34-43. 2006.
[27]  Cockram, J., Jenkins, S., & Clugston, R. Cardiovascular and respiratory responses to early ambulation and stair climbing following coronary artery surgery. Physiother Theory Pract; 15: 3-15. 1999.
[28]  Morris, P. E. Moving our critically ill patients: mobility barriers and benefits. Crit Care Clin. 23: 1-20. 2007.
[29]  Perme, C., & Chandrashekhar, R. Early mobility and walking program for patients in ICU, creating a standard for care. American Journal of Critical Care. 18(3): 212-221. 2009.
[30]  Stephens, S. R., & Whitman, G. J. Postoperative critical care of the adult cardiac surgical patient. Part I: Routine postoperative care. Crit Care Med. 43(7): 1477-1497. 2015.
[31]  Stiller, K. Physiotherapy in Intensive care. Towards an evidence-based practice. Chest. 118(6):1801-13. 2000.
[32]  Torres, D.C., Santos, P. M., Reis, H. J., Paisani, D. M., & Chiavegato, L. D. Effectiveness of an early mobilization program on functional capacity after coronary artery bypass surgery: A randomized controlled trial protocol. SAGE Open Medicine. 4: 1-8. 2017.
[33]  Moreno-Lacalle, R.C. Nurturing the seeds of evidence-based practice: Early ambulation among cardiac surgery patients. International Journal of Evidence-Based Health care (S19). 2016, University of Adelaide, Joanna Briggs Institute.
[34]  Zafiropoulos B., Alison J., & McCarren B. Physiological responses to the early mobilization of the intubated, ventilated abdominal surgery patients, Aust J Physiother. 50:95–100. 2004.
[35]  Arbane, G., Douiri, A., Hart, N., Hopkinson, N. S., Singh, S., Speed, C., et al. Effect of postoperative physical training on activity after curative surgery for non-small cell lung cancer: a multicentre randomized controlled trial. Physiotherapy. 100(2): 100-7. 2014.
[36]  Kim A. H., & Kim, Y. K. The effect of semi-fowler’s position on post-operative recovery in recovery room for patients with laparoscopic abdominal surgery. Korean Journal of Adult Nursing. 16(4): 566-574. 2004.
[37]  Camargo, P. R., Fogaça-Kawaguchi, Y. M., Sayuri-Hirota, A., Fu, C., Tanaka, C., Caruso, P., et al. Very early passive cycling exercise in mechanically ventilated critically ill patients: Physiological and safety aspects - a case series. PLoS ONE. 8(9): e74182; 1-5. 2013.
[38]  Younis, G. A., & Ahmed, S. E. Effectiveness of passive range of motion exercises on hemodynamic parameters and behavioral pain intensity among adult mechanically ventilated patients. IOSR Journal of Nursing and Health Science. 4(6): 47-59. 2015.
[39]  Stiller, K., Phillips, A., and Lambert, P. The safety of mobilization and its effect on hemodynamic and respiratory status of intensive care patients, Physiother Theory Pract. 20:175-85. 2004.
[40]  Burtin, C., Clerckx, B., Robbeets, C., Ferdinande, P., Langer, D., Troosters, T., et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009; 37(9): 2499-2505. 2009.
[41]  Clark, D. E., Lowman, J. D., Griffin, R. L., Matthews, H. M., & Reiff, D. A. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Physiotherapy. 93:186-96. 2013.
[42]  Genc, A., Koca, U., & Gunerli, A. What are the hemodynamic and respiratory effects of passive limb exercise for mechanically ventilated patients receiving low-dose vasopressor/inotropic support. Crit Care Nurs Quarterly J. 37(2):152-158. 2014.
[43]  Adler J., & Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulmonary Physical Therapy Journal. 23(1): 5-13 5. 2012.