Overview
This study aims to determine whether starting respiratory physiotherapy one hour after removal of the breathing tube following elective coronary artery bypass graft (CABG) surgery leads to better recovery than the current standard approach, in which physiotherapy begins on the first postoperative day. The study will evaluate whether earlier physiotherapy improves lung function, reduces postoperative pulmonary complications, shortens intensive care unit and hospital stay, decreases pain and anxiety, and improves overall recovery after surgery. The main question is whether very early postoperative respiratory physiotherapy provides additional benefits for patients recovering from elective heart surgery compared with standard postoperative care.
Description
This study is designed to evaluate the effectiveness of early postoperative physiotherapy initiated one hour after extubation in patients undergoing elective coronary artery bypass graft (CABG) surgery. Postoperative pulmonary complications remain among the most frequent causes of morbidity following cardiac surgery and may contribute to prolonged intensive care unit and hospital stay, delayed functional recovery, and increased healthcare utilization. Early physiotherapy has been recognized as an important component of postoperative rehabilitation; however, the optimal timing for its initiation has not been clearly established. This study aims to investigate whether initiating physiotherapy one hour after extubation provides additional clinical benefits compared with the current standard practice of commencing physiotherapy on the first postoperative day. The protocol includes standardized perioperative management and physiotherapy procedures to ensure consistency of the intervention and outcome assessment. The study will be conducted at the University Hospital Centre Zagreb in accordance with the principles of Good Clinical Practice, the Declaration of Helsinki, and applicable ethical and regulatory requirements.
Eligibility
Inclusion Criteria:
- Adults aged 18-80 years
- Male and female participants
- Elective coronary artery bypass grafting (CABG)
- Body mass index (BMI) \< 30 kg/m²
- Left ventricular ejection fraction (EF) \> 25%
- Extubated on postoperative day 0 (POD 0)
- Able and willing to provide written informed consent
- Able to perform spirometry and follow study instructions
Exclusion Criteria:
- Refusal or inability to provide informed consent
- Emergency CABG surgery
- Previous cardiac surgery
- Severe cardiac arrhythmias (e.g., ventricular tachycardia/fibrillation, third-degree atrioventricular block)
- Previous stroke
- Motor impairment of upper or lower extremities due to neurological or musculoskeletal disease
- Dyskinesia
- Not extubated on POD 0
- Significant postoperative neurological complications
- Peripheral arterial disease of the lower extremities or previous lower-limb amputation
- Acute or chronic pulmonary disease
- Preoperative FEV1 \<30% of predicted (greater than 70% reduction)
- Inability to perform spirometry correctly
- Cancelled surgery after preoperative assessment
- Extubation later than 24 hours after surgery
- Requirement for continuous positive airway pressure (CPAP) after extubation SpO₂ \<90% one hour after extubation despite oxygen supplementation (4 L/min by nasal cannula)
- Return to the operating room after the initial CABG procedure
- Requirement for dialysis (acute or chronic)
