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

Early postoperative 30? lateral positioning after coronary artery surgery: influenceon cardiac outputAims and objectives. We investigated whether: (i) Early postoperative lateral positionafter coronary artery bypass surgery may have a negative influence on thecardiac output and (ii) Whether turning procedures cause practical problems.Background. Directly following surgery, coronary artery bypass patients are notreceiving routine turning every two hours to prevent pressure ulcers, because anegative influence on hemodynamic parameters is assumed.Design. Clinical trial.Methods. Fifty-five coronary artery bypass patients were randomly assigned to fourintervention regimens and underwent a two-hour period of 30? lateral position.Fourteen patients in supine position served as a reference group. We hypothesizedthat 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 cardiacindex, not even in the patients in a poor hemodynamic condition. The cardiac indexin 30? lateral position and supine position two to eight hours postoperatively aftercoronary artery bypass surgery is statistically bioequivalent. No clinically relevantdeviations 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 problemshindering the turning regimen, not even in the patients with an intra-aortic balloonpump.Conclusions. Early postoperative turning of coronary artery bypass surgery patientsin lateral position is an easy and feasible procedure that does not influence thecardiac index not even in patients receiving antihypertensive or inotropic/vasopressortherapy. Further research is needed to find out whether our findings are alsovalid in other patient groups and other position conditions.Relevance to clinical practice. If there are no strict contra-indications, lateralposition has to be considered to prevent complications of continuous supine positionwithin two hours after coronary artery bypass surgery patients have been admittedto the intensive care unit.