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Subaraknoid kanamalı hastalarda ameliyat sonrası lateral pozisyonun hasta sonuçlarına etkisi

Year 2023, Volume: 48 Issue: 3, 1053 - 1061, 30.09.2023
https://doi.org/10.17826/cumj.1277791

Abstract

Amaç: Bu çalışma, subaraknoid kanamalı hastalarda ameliyat sonrası verilen lateral pozisyonun hasta sonuçlarına etkisini belirlemek amacıyla yapılmıştır.
Gereç ve Yöntem: Randomize kontrollü müdahale çalışması olan bu çalışma, bir üniversite hastanesinin beyin cerrahisi yoğun bakım ünitesinde subaraknoid kanama cerrahisi geçiren ve örneklem kriterlerini taşıyan 42 (deney grubu: 21, kontrol grubu: 21) hasta ile gerçekleştirildi. Araştırmada veri toplama aracı olarak “Hasta Tanımlayıcı Bilgi Formu” ve “Hasta Sonuç Formu” kullanılmıştır. Subaraknoid kanama nedeniyle opere edilen toplam 42 hasta çalışmaya dahil edildi. Müdahale grubundaki hastalar ilk 72 saat boyunca 2-4 saatte bir sol lateral, sağ lateral ve semi-fowler pozisyonunda (30 derece) yatırılırken, kontrol grubundaki hastalar rutin olarak semi-fowler (20 ila 45 derece) pozisyonuna yerleştirildi.
Bulgular: Müdahale grubunda 48. saatte hidrojen değerinin gücü ve parsiyel oksijen basıncı ve arteriyel oksijen satürasyonu 72. saatte kontrol grubuna göre istatistiksel olarak anlamlı derecede yüksekti. Müdahale grubunda sadece 72. saatte kalp hızında hafif bir azalma gözlendi, bu normale yakındı.
Sonuç: 2 ila 4 saatlik aralıklarla lateral ve semi-fowler pozisyonlarının oksijenizasyonun iyileşmesine katkıda bulunduğu ve subaraknoid kanamanın ikincil komplikasyonlarını önlediği saptanmıştır.

Project Number

TYL-2019-12363

References

  • Kızılkılıç EK, İnce FB. Clinical and examination findings in cerebral aneurysms.Diagn Interv Radiol. 2022;10:1-9.
  • Lindgren A, Vergouwen MD, Van der Schaaf I, Algra A, Wermer M, Clarke M. J et al. Endovascular coiling versus neurosurgical clipping for people with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2018;8:8.
  • Urfali B, Serarslan Y. Factors affecting prognosis in subarachnoid hemorrhage. Turk Neurosurg. 2018;28:129-31.
  • Göker B, Akçakaya MO, Hamamcıoğlu MK, Kırış T. Cerebral vasospasm: clinical follow-up and treatment. Turk Neurosurg. 2018;28:119-23.
  • Onuk E, Kabataş S, Civelek E. Fluid and electrolyte imbalance in head trauma. Turk Neurosurg. 2020;30:250-53.
  • Alarcon JD, Rubiano AM, Okonkwo DO, Alarcón J, Martinez-Zapata M J, Urrútia G et al. Elevation of the head during intensive care management in people with severe traumatic brain injury. Cochrane Database Syst Rev. 2017;8-12.
  • Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80:6-15.
  • American Association of Neuroscience Nurses. American association of neurosurgical nurses primary brain tumors nursing care guidelines. https://www.aann.org (Access Date:27.10.2021).
  • Abd El-Moaty AM, EL-Mokadem NM, Abd-Elhy AH. Effect of semi fowler’s positions on oxygenation and hemodynamic status among critically ill patients with traumatic brain ınjury.Novelty Journals. 2017;4:227-36.
  • Jiang Y, Ye ZPP, You C, Hu X, Liu Y, Li H et al. Systematic review of decreased intracranial pressure with optimal head elevation in post craniotomy patients: a meta-analysis. J Adv Nurs. 2015;71:2237-46.
  • Marehbian J, Muehlschlegel S, Edlow BL, Hinson HE, Hwang DY. Medical management of the severe traumatic brain injury patient.Neurocrit Care. 2017;27:430-46.
  • Hewitt N, Bucknall T, Faraone NM. Lateral positioning for critically ill adult patients. Cochrane Database Syst Rev. 2017;5-24.
  • Ledwith MB, Bloom S, Maloney-Wilensky E, Coyle B, Polomano RC, Le Roux PD. Effect of body position on cerebral oxygenation and physiologic parameters in patients with acute neurological conditions. J Neurosci Nurs. 2010;42:280-87.
  • Hifumi T, Yamakawa K, Shiba D, Okazaki T, Kobata H, Gotoh J et al. Head positioning in suspected patients with acute stroke from prehospital to emergency department settings: a systematic review and meta‐analysis. Acute Med Surg..202;8:e631-38.
  • Ismail AS, Mohammad SY, Mourad AH. Effect of body position on oxygenation and hemodynamic status among patients with traumatic brain ınjury. Evid Based Nurs Res. 2021;3:29-43.
  • Mehta JN, Parmar LD. The effect of positional changes on oxygenation in patients with head injury in the intensive care unit. J Family Med Prim Care. 2017;6:853-58.
  • Gok F, Yurtseven F. Nursing care of the patient receiving mechanical ventilator support in the ıntensive care unit. Mas Japs. 2022;7:528-36.
  • Taha AS, Omran ES, Mahmoud EA. Effectiveness of semi-fowler's position on hemodynamic function among patients with traumatic head ınjury. J Nurs Sci. 2021;2:89-108.
  • Mezidi M, Guérin C. Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients. Ann Transl Med. 2018;6:384-93.1
  • Mohammed HM, El-Sayed ZA. Effect of different therapeutic positions on selected vital parameters among patients with stroke: randomized control trial. J Assiut Sci Nurs. 2022;10:95-107.
  • Tuncer M, Khorshtd L. The effect of positions on oxygen saturation in obese individuals. J Ege Univ Faculty of Nurs. 2018;34:54-65.
  • Ali GM, Ahmed AM, Mohamed Zaky HE. Effect of changing selected body positions on oxygen saturation among patients with acute stroke. J Minia Sci Nurs. 2021;9:71-8.
  • Ceylan B, Khorshid L, Güneş ÜY, Zaybak A. Evaluation of oxygen saturation values in different body positions in healthy individuals. J Clin Nurs. 2016;25:1095-100.
  • Özden TOR, Gülçay MERT, Tosun B. The effect of positions given to intensive care patients on hemodynamic measurements. J Dokuz Eylul Univ Faculty of Nurs Elec. 2019;12:15-20.
  • Aries MJ, Aslan A, Elting JWJ, Stewart RE, Zijlstra JG, De Keyser J et al. Intra-arterial blood pressure reading in intensive care unit patients in the lateral position. J Clin Nurs. 2011;21:1825-30.
  • Hermes C, Nydahl P, Henzler D, Bein T. Positioning therapy and early mobilization in intensive care units: Findings from the current 2015 guidelines.Med Klin Intensivmed Notfmed. 2016;111:567-79.
  • Sasaki K, Haga M, Bao S, Sato H, Saiki Y, Maruyama R. The cardiac sympathetic nerve activity in the elderly is attenuated in the right lateral decubitus position. Gerontol Geriatr Med. 2017;3:1-9.

Effects of postoperative lateral positioning on outcomes of patients with subarachnoid hemorrhage

Year 2023, Volume: 48 Issue: 3, 1053 - 1061, 30.09.2023
https://doi.org/10.17826/cumj.1277791

Abstract

Purpose: This study was conducted to investigate the effects of postoperative lateral positioning on the patients’ outcomes with subarachnoid hemorrhage.
Materials and Methods: This study, which is a randomized controlled intervention study, was conducted with 42 (experimental group: 21, control group: 21) patients who underwent subarachnoid hemorrhage surgery in the neurosurgery intensive care unit of a university hospital and met the sampling criteria. In the study, "Patient Descriptive Information Form" and "Patient Results Form" were used as data collection tools. A total of 42 patients operated on for subarachnoid hemorrhage were included in the study. While the patients in the intervention group were placed in the left lateral, right lateral, and semi-fowler position (30 degrees) every 2 to 4 hours for the first 72 hours, those in the control group were routinely placed in the semi-fowler position (20 to 45 degrees).
Results: The power of hydrogen value and partial oxygen pressure and arterial oxygen saturation at the 48th hour in the intervention group were statistically significantly higher than the control group at the 72nd hour. In the intervention group, a slight decrease was observed only in the heart rate at 72 hours, which was near normal.
Conclusion: Lateral and semi-fowler positions with a 2 to 4 hour interval contributed to improved oxygenation and prevented secondary complications of subarachnoid hemorrhage.

Supporting Institution

Cukurova University Scientific Research Coordination Unit

Project Number

TYL-2019-12363

Thanks

We thank all relatives and/or legal guardians of the patients for their participation in this study. Also, we would like to thank The Project Unit of Cukurova University for supporting this project.

References

  • Kızılkılıç EK, İnce FB. Clinical and examination findings in cerebral aneurysms.Diagn Interv Radiol. 2022;10:1-9.
  • Lindgren A, Vergouwen MD, Van der Schaaf I, Algra A, Wermer M, Clarke M. J et al. Endovascular coiling versus neurosurgical clipping for people with aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2018;8:8.
  • Urfali B, Serarslan Y. Factors affecting prognosis in subarachnoid hemorrhage. Turk Neurosurg. 2018;28:129-31.
  • Göker B, Akçakaya MO, Hamamcıoğlu MK, Kırış T. Cerebral vasospasm: clinical follow-up and treatment. Turk Neurosurg. 2018;28:119-23.
  • Onuk E, Kabataş S, Civelek E. Fluid and electrolyte imbalance in head trauma. Turk Neurosurg. 2020;30:250-53.
  • Alarcon JD, Rubiano AM, Okonkwo DO, Alarcón J, Martinez-Zapata M J, Urrútia G et al. Elevation of the head during intensive care management in people with severe traumatic brain injury. Cochrane Database Syst Rev. 2017;8-12.
  • Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80:6-15.
  • American Association of Neuroscience Nurses. American association of neurosurgical nurses primary brain tumors nursing care guidelines. https://www.aann.org (Access Date:27.10.2021).
  • Abd El-Moaty AM, EL-Mokadem NM, Abd-Elhy AH. Effect of semi fowler’s positions on oxygenation and hemodynamic status among critically ill patients with traumatic brain ınjury.Novelty Journals. 2017;4:227-36.
  • Jiang Y, Ye ZPP, You C, Hu X, Liu Y, Li H et al. Systematic review of decreased intracranial pressure with optimal head elevation in post craniotomy patients: a meta-analysis. J Adv Nurs. 2015;71:2237-46.
  • Marehbian J, Muehlschlegel S, Edlow BL, Hinson HE, Hwang DY. Medical management of the severe traumatic brain injury patient.Neurocrit Care. 2017;27:430-46.
  • Hewitt N, Bucknall T, Faraone NM. Lateral positioning for critically ill adult patients. Cochrane Database Syst Rev. 2017;5-24.
  • Ledwith MB, Bloom S, Maloney-Wilensky E, Coyle B, Polomano RC, Le Roux PD. Effect of body position on cerebral oxygenation and physiologic parameters in patients with acute neurological conditions. J Neurosci Nurs. 2010;42:280-87.
  • Hifumi T, Yamakawa K, Shiba D, Okazaki T, Kobata H, Gotoh J et al. Head positioning in suspected patients with acute stroke from prehospital to emergency department settings: a systematic review and meta‐analysis. Acute Med Surg..202;8:e631-38.
  • Ismail AS, Mohammad SY, Mourad AH. Effect of body position on oxygenation and hemodynamic status among patients with traumatic brain ınjury. Evid Based Nurs Res. 2021;3:29-43.
  • Mehta JN, Parmar LD. The effect of positional changes on oxygenation in patients with head injury in the intensive care unit. J Family Med Prim Care. 2017;6:853-58.
  • Gok F, Yurtseven F. Nursing care of the patient receiving mechanical ventilator support in the ıntensive care unit. Mas Japs. 2022;7:528-36.
  • Taha AS, Omran ES, Mahmoud EA. Effectiveness of semi-fowler's position on hemodynamic function among patients with traumatic head ınjury. J Nurs Sci. 2021;2:89-108.
  • Mezidi M, Guérin C. Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients. Ann Transl Med. 2018;6:384-93.1
  • Mohammed HM, El-Sayed ZA. Effect of different therapeutic positions on selected vital parameters among patients with stroke: randomized control trial. J Assiut Sci Nurs. 2022;10:95-107.
  • Tuncer M, Khorshtd L. The effect of positions on oxygen saturation in obese individuals. J Ege Univ Faculty of Nurs. 2018;34:54-65.
  • Ali GM, Ahmed AM, Mohamed Zaky HE. Effect of changing selected body positions on oxygen saturation among patients with acute stroke. J Minia Sci Nurs. 2021;9:71-8.
  • Ceylan B, Khorshid L, Güneş ÜY, Zaybak A. Evaluation of oxygen saturation values in different body positions in healthy individuals. J Clin Nurs. 2016;25:1095-100.
  • Özden TOR, Gülçay MERT, Tosun B. The effect of positions given to intensive care patients on hemodynamic measurements. J Dokuz Eylul Univ Faculty of Nurs Elec. 2019;12:15-20.
  • Aries MJ, Aslan A, Elting JWJ, Stewart RE, Zijlstra JG, De Keyser J et al. Intra-arterial blood pressure reading in intensive care unit patients in the lateral position. J Clin Nurs. 2011;21:1825-30.
  • Hermes C, Nydahl P, Henzler D, Bein T. Positioning therapy and early mobilization in intensive care units: Findings from the current 2015 guidelines.Med Klin Intensivmed Notfmed. 2016;111:567-79.
  • Sasaki K, Haga M, Bao S, Sato H, Saiki Y, Maruyama R. The cardiac sympathetic nerve activity in the elderly is attenuated in the right lateral decubitus position. Gerontol Geriatr Med. 2017;3:1-9.
There are 27 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Ceylan Kişial 0000-0002-0800-1660

Sevilay Erden 0000-0002-6519-864X

Project Number TYL-2019-12363
Early Pub Date September 26, 2023
Publication Date September 30, 2023
Acceptance Date September 8, 2023
Published in Issue Year 2023 Volume: 48 Issue: 3

Cite

MLA Kişial, Ceylan and Sevilay Erden. “Effects of Postoperative Lateral Positioning on Outcomes of Patients With Subarachnoid Hemorrhage”. Cukurova Medical Journal, vol. 48, no. 3, 2023, pp. 1053-61, doi:10.17826/cumj.1277791.