Early goal-directed mobilization in patients with acute type A aortic dissection: A randomized controlled trial

Abstract

Objective To determine the safety and efficacy of early postoperative mobilization in patients who have undergone surgical repair of acute type A aortic dissection. Design Randomized controlled trial. Setting Heart Medical Center. Subjects Seventy-seven patients with acute type A aortic dissection were assessed. Intervention Patients were randomly allocated into: (1) the control group (usual care) ( n  =  38) and (2) the intervention group (early goal-directed mobilization) ( n  =  39). Main Measures The primary outcome was the patient's functional status. The secondary outcomes included vital signs, serious adverse events, muscle strength, intensive care unit-acquired weakness, grip strength, duration of mechanical ventilation, length of stay, readmission rate, and health-related quality of life after 3 months. Results The vital signs of the patients were within the tolerable ranges during the entire intervention. No serious exercise-related adverse events were observed in the intervention group. The Barthel Index score ( P  =  0.013), Medical Research Council score ( P  =  0.001), grip strength ( P  =  0.001), and health-related quality of life ( P  =  0.001) were higher in the intervention group. Intensive care unit acquired weakness ( P  =  0.019), duration of mechanical ventilation ( P  =  0.002), intensive care unit stay ( P  =  0.002), and total length of stay ( P  =  0.010) were lower in the intervention group. Patients in the intervention group had a higher physical health-related quality of life ( P  =  0.015) at 3 months post-surgery. There was no difference in readmission rates. Conclusions Delivery of early goal-directed mobilization in acute type A aortic dissection was safe and facilitated the recovery of daily living ability, shorter hospital stay, and improved quality of life after discharge.