The effect of reverse Trendelenburg position versus semi-recumbent position on respiratory parameters of obese critically ill patients: A randomised controlled trial

The effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position: A quasi-experimental study

AIMS

The aim of this study was to research the effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position.

METHODS

This study was a non-randomized and non-controlled, quasi-experimental repeated measures study. The study was conducted with 50 intensive care patients aged 18 and over in a general surgery intensive care unit in Turkey. With each patient in the supine position, the bed head was raised to an angle of 0°, 20°, 30°, and 45° without a pillow, and the hemodynamic parameters of central venous pressure, systolic and diastolic blood pressure, heart rate, breathing rate, and peripheral oxygen saturation were recorded after 0 and 10 min.

RESULTS

It was found that the mean central venous pressure value measured at min 0 and 10 was higher when the intensive care patients' bed head angle was raised to 45° than when the bed head was at an angle of 0° or 20° (p < .05). It was found that the patients' other hemodynamic parameters were not affected by different bed head angles.

CONCLUSIONS

It was concluded as a result of this research that in intensive care patients in the supine position, only central venous pressure was affected by bed head angle, and that central venous pressure measurement can be reliably made at a bed head angle of 30°.

Cardiac surgery in the morbidly obese

BACKGROUND

Obesity rates globally continue to rise and in turn the body mass index (BMI) of patients undergoing cardiac surgery is set to mirror this. Patients who are Class III obese (BMI ≥ 40) pose significant challenges to the surgical teams responsible for their care and are also at high risk of complications from surgery and even death. To improve outcomes in this population, interventions carried out in the preoperative, operative, and postoperative periods have shown promise. Despite this, there are no defined best practice national guidelines for perioperative management of obese patients undergoing cardiac surgery.

AIM

This review is aimed at clinicians and researchers in the field of cardiac surgery and aims to form a basis for the future development of clinical guidelines for the management of obese cardiac surgery patients.

METHODS

The PubMed database was utilized to identify relevant literature and strategies employed at various stages of the surgical journey were analyzed.

CONCLUSIONS

Data presented identified the benefits of preoperative respiratory muscle training, off-pump coronary artery bypass grafting where possible, and early extubation. Further randomized controlled trials are required to identify optimal operative and perioperative management strategies before the introduction of such guidance into clinical practice.

Care of abdominal skin in ankylosing spondylitis patients undergoing corrective spinal surgery

The present study aimed to investigate the effect of a new method of abdominal skin care on patients with ankylosing spondylitis (AS) undergoing orthopedic surgery. A total of 90 patients with AS and thoracolumbar kyphosis undergoing orthopedic surgery were randomly divided into two groups. Patients in the control group received routine care while those in experimental group received the following new treatment regimen: i) Vaseline cream was applied to the abdominal skin for 3-5 min every 6 h; ii) preoperative stretch exercises were encouraged and iii) 24 h after surgery, the patient was placed in a lateral decubitus position. The difference in abdominal pain levels and the size of tension blisters was the compared between the two groups. There was no difference in age, gender, disease course and kyphosis angle between two groups (P>0.05). Compared with the patients in the control group, those in test group experienced milder pain when evaluated by visual analogue score at 6, 18 and 30 h after surgery (3.6±1.2 vs. 4.5±1.8; 4.4±2.3 vs. 6.1±2.7; 4.1±2.1 vs. 4.1±2.1, P<0.05). Moreover, tension vesicles in the abdominal skin were significantly smaller in the treatment group than the control group (P<0.05). Optimal nursing may be the key to the reduction of the level of pain and occurrence of tension vacuoles in the abdominal skin.