Critical care nursing in acute postoperative neurosurgical patients

Evaluation of the effect of endotracheal aspiration at different head heights on oxygenation of the brain by non-invasive method in intensive care patients

OBJECTIVES

To determine the effect of endotracheal aspiration at different head heights on oxygenation brain by non-invasive method in neurosurgery intensive care patients.

BACKGROUND

Head elevation of mechanical ventilator-dependent neurosurgery patients and the possible risks of endotracheal aspiration are closely related to the clinical conditions of the patients.

DESIGN

A prospective quasi-experimental study with repetitive measurements in a single group.

METHODS

In the study, neurosurgery intensive care patients were adjusted to a head height of 15, 30 and 45° (n = 46, power analysis %90). Cerebral oxygenation levels were determined with a non-invasive device at each head height before and in the 1st, 5th and 30th min of endotracheal aspiration. Data were collected with Patient Information Form and cerebral oxygenation device based on NIRS technology. This study performed according to the TREND reporting guidelines for non-randomized/quasi experimental study.

RESULTS

The highest cerebral oxygenation value was obtained at 30 min. The decrease in the cerebral oxygenation levels of the patients was highest in the 1st min after endotracheal aspiration, at a head height of 15 degrees for the right cerebral region and at a head height of 30 degrees for the left cerebral region. The increase in oxygenation of the right and left cerebral regions occurred highest at a head height of 45 degrees.

CONCLUSIONS

The ideal head height should be 45 degrees during and after endotracheal aspiration in regard to maintaining cerebral oxygenation in neurosurgery intensive care patients. It is extremely important to monitor the cerebral oxygenation status of patients, with non-invasive measurement tools during and after endotracheal aspiration, to prevent secondary complications.

RELEVANCE TO CLINICAL PRACTICE

This study reveals the importance of raising the head 45 degrees in the best preservation of cerebral oxygenation values in neurosurgery intensive care patients. Intensive care nurses should pay attention to maintaining this head height.

Association between registered nurse staffing levels and in-hospital mortality in craniotomy patients using Korean National Health Insurance data

BACKGROUND

The level of registered nurse (RN) staffing is a fundamental factor influencing patient safety. Craniotomy patients need intensive care after surgery, the majority of which is provided by RNs.

METHODS

This study was conducted to investigate the relationship of the RN staffing level of general wards and intensive care units (ICUs) with in-hospital mortality after craniotomy using Korean National Health Insurance claim data. The RN staffing level was categorized based on the bed-to-RN ratio.

RESULTS

The in-hospital mortality rate of craniotomy patients was elevated at hospitals with a high bed-to-RN ratio in general wards, ICUs, and hospitals overall. It was determined that in-hospital mortality of craniotomy patients could be decreased by more than 50% by reducing the bed-to-RN ratio from 4.5 or more to less than 3.5 in general wards, from 1.25 or more to less than 0.88 in ICUs, and from 2.5 or more to less than 1.67 in hospitals overall.

CONCLUSIONS

Since the RN staffing level is related to the in-hospital mortality rate of craniotomy patients, a sufficient staffing level of RNs should be ensured to reduce the mortality of craniotomy patients.

Clinical analysis of perioperative nursing of aortic coarctation

BACKGROUND

The aim of this study is to explore the treatment experience of the perioperative nursing of coarctation of the aorta.

METHODS

From June 2012 to December 2013, a total of 15 children diagnosed with coarctation of the aorta were retrospectively studied and sorted into the observation group in our hospital. Also, 12 children admitted between January 2010 and December 2012 was sorted into control group. Combined intravenous anesthesia and cardiopulmonary bypass were conducted on all the children. Children in observation group underwent perioperative nursing, including preoperative nursing (evaluating disease conditions, improving preoperative preparation and preoperative discussion) and postoperative nursing (transferred into ICU, respiratory management, circulation system management, nutrition support nursing, using intravenous drugs). Children in the control group were treated with common nursing. Clinical effects of both groups were compared.

RESULTS

Fourteen of 15 cases in the treatment group were cured and discharged from the hospital after a 6~12-month follow-up. All patients had good prognosis, except one case quit the treatment and left hospital for obstinate low output syndrome.

CONCLUSIONS

With the improvement in the skills of a repair operation, extracorporeal circulation and monitoring as well as nursing, the restenosis incident rate and morality rate were effectively reduced. Meanwhile, taking an initiative for comprehensive prevention nursing measures during peri-operation is an important guarantee to a successful operation and prognosis.