EARLY MOBILIZATION OF CARDIOSURGICAL PATIENTS: PERFORMANCE BARRIERS, PRO-TOCOLS AND EFFICIENCY

Purpose: according to research to determine the current provisions on early mobilization of cardiac surgery patients, obstacles to its implementation, features of practical implementation and effectiveness. Materials and methods of research: this work is the result of analysis and comparison of research results on the problem of early mobilization of patients after cardiac surgery in physical therapy programs. Results. At the beginning of the development of cardiac surgery, patients were in bed for several days after surgery to prevent complications and promote re-covery. Over time, the benefits of early mobilization were recognized, and the time of sitting and standing of the patient gradually decreased. The benefits of early mobili-zation after cardiac surgery are associated with a reduced risk of venous thromboembolism and pulmonary embo-lism, improved airway clearance and prevention of pneumonia, reduced deconditioning and rehabilitation needs, and reduced patient stay. On the other hand, the practical implementation of early mobilization has a number of obstacles, which requires an increase in the time allocated to one patient, and, accordingly, a decrease in the patient / physical therapist ratio. Barriers to early mobilization include those related to the patient (patient's condition, hemody-namic or respiratory instability, pain, obesity, sedation, delirium, agitation, condition monitoring equipment), as well as staff shortages, lack of protocol , patient mobility cultures, planning and coordination, multidisciplinary approach, insufficient staff remuneration, unclear roles and responsibilities; appointment of a permanent bed rest, risks for performers. The average criteria for early mobilization of cardiac surgery patients are currently marked by the fact that on the first postoperative day patients sit and stand under the supervision of a physical therapist; on the se-cond day - walked in the ward or for a short distance in the corridor; on the third day - increase the walking dis-tance. Researchers have confirmed the variety of tech-niques used for mobilization, as well as the periods that are considered early. The advantages between different protocols for early mobilization of cardiac surgery pa-tients are not noted. At the same time, there are research-es that do not find positive effects from early mobiliza-tion. This may be due to the fact that modern standard mobilization protocols were called "early" some time ago, and have shown their effectiveness in implementation, as past standard protocols have excessively prolonged bed rest. On the other hand, modern early mobilization protocols may differ slightly from modern standard ones or even require irrationally early mobilization. As a result, their effectiveness will be absent. Given the results of research, in early mobiliza-tion should be guided by the principle of rationality with the coordination of the patient's capabilities and tasks and adhere to the time norms in the form of "not too early and not too late." Conclusions. The question of the usefulness of early mobilization is not fully resolved. There is both confirmation and refutation of effectiveness in the litera-ture. The quality and quantity of research is also consid-ered insufficient.