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  3. Comparison of changes in intra-abdominal pressure in 0, 15 and 30 degrees head of bed position in patients hospitalized in special care departments of medical training centers in Rasht city in 2010-2019

Comparison of changes in intra-abdominal pressure in 0, 15 and 30 degrees head of bed position in patients hospitalized in special care departments of medical training centers in Rasht city in 2010-2019

Number of pages: 99 File Format: word File Code: 32017
Year: 2012 University Degree: Master's degree Category: Medical Sciences
Tags/Keywords: IAH - IAP - Increased blood pressure - Intra-abdominal blood pressure - Intra-abdominal hypertension - Intra-abdominal pressure - Raise the head of the bed - Special care units
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  • Summary of Comparison of changes in intra-abdominal pressure in 0, 15 and 30 degrees head of bed position in patients hospitalized in special care departments of medical training centers in Rasht city in 2010-2019

    Dissertation for Master of Nursing Care

    Introduction: Increased intra-abdominal pressure (IAP) is known as an independent risk factor for mortality among patients in intensive care units, and the prevalence of intra-abdominal hypertension (IAH) is reported to be up to 58%. The effect of changing the body position (elevating the head of the bed) on the accuracy of the IAP measurement, in order to reduce the risk of ventilator-associated pneumonia, is not yet fully known.

    Aim: This research was conducted to compare the IAP changes in the position of zero, 15 and 30 degrees of the head of the bed in patients hospitalized in intensive care units.

    Experimental materials and methods: in this semi-sized study IAP was measured by the Korn method every 8 hours for 24 hours in three positions of 0, 15, and 30 degrees of the head of the bed on 76 mechanically ventilated patients over 18 years of age hospitalized in the intensive care unit who were at risk of IAH. Then the average IAP in 24 hours and the range of agreement and the error rate using the Bland and Altman test based on the range mentioned by the International Association of Abdominal Compartment Syndrome (-4 to +4 and 1 mm Hg) were compared.

    Results: The findings showed that the IAP increases statistically with the increase of the angle of the head of the bed. 2/66 and 1/66 to 6/89 [showed.

    Conclusion: Elevating the head of the bed leads to a significant increase in IAP measurement, and until the reasons and accuracy of IAP measurement in positions other than zero are determined by conducting more research, it is recommended to perform IAP measurement at zero degrees if the patient tolerates it, and otherwise pay attention to this difference.

    keyword: increased intra-abdominal blood pressure, intensive care unit, inpatients

    Problem statement:

    Intra-abdominal pressure ([1]) (IAP) has been increasingly considered as an important physiological factor in intensive care unit patients (2,1). Increased intra-abdominal pressure is a silent clinical process that is not diagnosed until it is completely advanced. The World Society of Abdominal Compartment Syndrome (WSACS) [2] has stated the incidence of intra-abdominal hypertension [3] (IAH) in intensive care unit patients from 18% to 58.8% and in critically ill internal and surgical patients 54.4-65% (2). This wide range varies in different clinical settings (surgical or internal), patient condition (trauma, burns, postoperative patients), variety of IAP measurement methods, and the number chosen to define intra-abdominal hypertension (12-25 mmHg) (3).  Therefore, IAH is known as an abdominal acute respiratory distress syndrome (ARDS [4]). Increased intra-abdominal pressure has different results and destructive effects on the surrounding tissues and other organs of the body. Ischemic effect occurs when the IAP reaches 10 mm Hg or more. But when the pressure reaches 20 mm Hg or higher, irreversible organ damage occurs, causing abdominal compartment syndrome. (4,2) .

    Rin Tam [5] et al.'s research showed that the daily mortality rate of patients with IAH admitted to the intensive care unit compared to patients without IAH was 37.9 vs. 19.1 in 28 days and 53.7 vs. 35.8 in 90 days, primary IAH as an independent risk factor for death. and mortality is known (5).

    Studies have shown that with the monitoring of IAP in hospitalized patients, and especially in patients hospitalized in special care units, the length of hospitalization is reduced between 10 and 13 days, and as a result, 2000 dollars in treatment costs can be saved 10,000 to 20,000 dollars will be saved (2).

    The findings in the Krebs study [6] showed that in patients undergoing mechanical ventilation, the adjustment of the mechanical ventilation device, especially [7] (PEEP) should be done according to the effects of intra-abdominal pressure on the chest and lung compliance.

    The findings in the Krebs study [6] showed that in patients under mechanical ventilation, the adjustment of the mechanical ventilation device ([7], especially PEEP should be done according to the effects of intra-abdominal pressure on the chest and lung compliance (6). On the other hand, increased intra-abdominal pressure can be a predictor of organ failure and mortality in this department. (7,3).

    Most intensive care unit patients are affected by various hemodynamic monitoring such as CVP ([8] and (CO[9]) What is often not paid attention to is the fact that various hemodynamic measurements are influenced by other factors such as mechanical ventilation and IAP (9,7,8). Despite the high prevalence of IAH and the importance of ACS and its control in patients hospitalized in intensive care units, pressure measurement Intra-abdominal has received less attention, and if abdominal compartment syndrome and its severe complications occur, only surgical treatment is used to reduce intra-abdominal pressure. Therefore, early diagnosis is necessary for adequate intervention and damage control (3). Acquiring nursing skills in order to diagnose patients at risk of IAH is fundamental and necessary to help reduce IAP and prevent ACS with early non-surgical interventions. Research has shown that in 40-60% of cases, clinical examinations have not been successful in diagnosing IAH compared to intra-abdominal pressure measurement (10,11). Serial measurement of IAP is essential for the diagnosis and treatment of IAH/ACS because the sensitivity of clinical examination is only 60% (13,12). Due to the importance of IAH, nurses should be especially aware of the process of intra-abdominal pressure measurement and its various aspects. On the other hand, if this issue is not taken into account, it will lead to errors in other hemodynamic measurements (16,14,15).

    Therefore, according to the recommendation of the International Society of Abdominal Compartment Syndrome, routine measurement in patients with two or more risk factors such as connection to mechanical ventilation, blood transfusion of more than 10 units in 24 hours, fluid intake of more than 5 liters per 24 hours, pneumonia[10], sepsis[11] and It should be done every 4-6 hours until the risk factor is removed (17).

    Usually, the standard position used to measure intra-abdominal pressure is zero degrees. However, for patients hospitalized in the special care department, this position can have irreversible consequences, including pneumonia, respiratory distress, and so on. have, especially when this measurement is done continuously. Therefore, the challenge that most special care nurses face is that when monitoring the patient's hemodynamics, including IAP, it is necessary for the patient to be placed in a supine position?(14)

    Promoting the patient's comfort and convenience through nursing interventions is an integral part of nursing care in special departments and is one of the duties of nurses. One of the aspects of comfort and comfort of the patient is to establish a suitable and comfortable position for the patient (18).

    There is evidence in the articles about the effect of body position on the measurement of intra-abdominal pressure, but the effect of the degree that is usually used for different positions of the bed angle in patients of intensive care units on intra-abdominal pressure is not clear (19). Measuring the intra-abdominal pressure in the zero-degree position, which is not the ideal position in intensive care patients, causes the intra-abdominal pressure to be measured lower than the level that patients often face (1, 13, 15). Research in the field of these patients, who cannot tolerate such a situation, like patients with heart failure, respiratory distress syndrome, sepsis or surgery, is not available enough (13). In addition, placing the patient in a supine position without raising the head of the bed even for a short period of time for the purpose of measuring intra-abdominal pressure increases the risk of aspiration pneumonia. This situation is contrary to the recommended policies of the Center for Disease Control for the prevention of this complication. In the recommended principles, it is emphasized in the patients of special care units that there should be at least 30 degrees of elevation of the head of the bed if it is not prohibited at the same time.

  • Contents & References of Comparison of changes in intra-abdominal pressure in 0, 15 and 30 degrees head of bed position in patients hospitalized in special care departments of medical training centers in Rasht city in 2010-2019

    List:

    Chapter One: Generalities

    1-1 Introduction (problem statement)..2

    1-2 research goals (general purpose and special goals).6

    1-3 research hypothesis..7

    1-4 scientific definitions of words..7

    1-5 practical definitions of words 8

    1-6 Presuppositions..9

    1-7 Limitations of the research. 9

    Chapter Two: Background and background of the research

    2-1 Research framework..11

    2-2 Overview of the conducted studies. Research..42

    2-3 type of research..42

    3-3 research community.42

    3-4 sampling.42

    3-5 sampling method.42

    3-6 characteristics of research units.43

    3-7 research environment.43

    3-8 data collection tools.43

    9-3 scientific validity or validity of the tool.

    3-10 data application methods.44

    3-11 methods of statistical analysis of data.45

    3-12 ethical considerations.47

    Chapter four: research results:

    4-1 research findings.49

    4-2 tables and Diagrams.50

     

    Chapter Five: Discussion and review of findings

    5-1 Analysis of findings.79

    5-2 Final conclusion.87

    5-3 Application of findings.89

    5-4 Suggestions for future research.90

    5-6 Sources and sources.91

    Source:

     

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    2.Carlson K., Abdominal compartment syndrome in the ill patient: A comprehensive review and implications for the acute care nursing practitioner. The university of Arizona, 2008, 1-69. 3. Murcia I., Sobino-Hernandez M., Garcis-L?pez F., et al. Usefulness of intra-abdominal pressure in a predominantly medical intensive care unit. Journal of critical care, 2010, 25, 175e1-175e6.

    4. Malbrain M., De laet I., De Walea J., IAH/ACS: The Rationale for Surveillance. World J Surg, 2009, 33, 1110 - 1115. 5. Reintam A., Parm P., Kern H., Starkopf J., Primary and secondary intra-abdominal hypertension __ different impact on ICU outcome.  Intensive Care Med, 2008, 34, 1624-1631.

    6. Krebs J., pelosi P., Tsagogiorg C., Lueke T., Effect of positive end-expiratory pressure on respiratory function and hemodynamics in patients with acute respiratory failure with and without intra-abdominal hypertension: a pilot study. Available from URL: http://www. ccforum.com/content /13/ 5 /R160.

     

    7. Reguria T., et al. Intra-abdominal hypertension incidence and association with organ dysfunction during early septic shock. Journal of critical care, 2008, 23, 461-467. 8. Wolfe T., Gallargher J., Intra-abdominal hypertension: pitfalls, prevalence and treatment options. critical care nursing, 2007, 234 - 244.

    9. Walsh Y., Bcur H., When and how should we measure intra-abdominal pressure? SAJCC, 2008, 24, 61-63. 10. Cheatham M., Intra-abdominal pressure monitoring during fluid resuscitation. critical care, 2008, 14, 327-333.

    11. Anderson R., Revision of the procedure for monitoring intra-abdominal pressure. critical care nursing, 2007, 27(5), 60-70.

    12.Vasquez D., Berg-Copas G., Wetta-Hall R., Influence of semi-recumbent position on intra-abdominal pressure as measured by bladder pressure. Journal of surgical research, 2007, 139, 280-285.

    13. McBeth P., Zygun D., Widder S., et al. Effect of patient positioning on intra-abdominal pressure monitoring. The American Journal of Surgery, 2007, 183, 644-647. 14. Rauen C., Makic B., Bridges E., Evidence-Based Practice Habits: Transforming Research Into Bedside Practice. critical care nursingShuster M., Haines T., Sekula K., Sekula K., Kern J., Vasquez J., Reliability of Intrabladder Pressure Measurement in Intensive Care.  American Journal of Critical Care, 2010, 19, 29-39.

    16. Keulenaer B., Waele J., Malbrain M., What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Med, 2009, 35, 969-976. 17. Available from URL: http:// www.wsacs.org/research_recommendations.php 18. Spencer P., Kinsman L., Fuzzard K., A critical care nurse, guide to intra-abdominal hypertension and abdominal compartment syndrome.  Australian Critical Care, 2008, 21, 18-28. 19. Chiaka Ejike J., Kadry J., Bajiri KH., Mthure M., Semi-recumbent position and body mass percentiles: effects on intra-abdominal pressure measurement in critically ill children. Intensive Care Med, 2010, 36, 329-335. 20. Mabrain M., Cheatham M., Kirpatrick A., et al. , Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med, 2006, 32, 1722-1732.

    21. Coyer F., Wheeler M., Wetzing S., et al., Nursing care of the mechanically ventilated patient: What does the evidence say? Part two. Intensive and critical care nursing, 2007, 23, 71-80.

    22. Efstathiou E., Zaka M. , Farmakis M. , et al., Intra-abdominal pressure monitoring in septic patients.  Intensive Care Medicine, 2005, 31, 175-183.

    23. Reintam, A., et al., Intra-abdominal hypertension as a risk factor of death in patients with severe sepsis or septic shock. Critical Care, 2007, 11, 310-319.

    24. Regueira T., Bruhn A., Hsbun P., et al., Intra-abdominal hypertension in patients with septic shock. American j Surgeon, 2007, 73, 865-70.

    25. Latenser, B.A., Critical care of the burn patient: the first 48 hours. Critical Care Med, 2009, 37, 2819-26.   

    26. Oda, J., Inoue T, Harunari N., Ode Y., et al., Resuscitation fluid volume and abdominal compartment syndrome in patients with major burns. Burns, 2006. 32, 151-154.

    27. Dambrauskas, Z., Parseliunas A., Gulbinas A., et al., Early recognition of abdominal compartment syndrome in patients with acute pancreatitis. World J Gastroenterol, 2009. 15, 17-21.

    28. Leppaniemi, A., K. Johansson, and J.J. De Waele, Abdominal compartment syndrome and acute pancreatitis. Acta Clin Belg Suppl, 2007, 131-135.

    29. Dabrowski, W., Rzecki Z., Intra-abdominal and abdominal perfusion pressure in patients undergoing coronary artery bypass graft surgery. Acta Clin Belg, 2009, 64, 216-224.

    30. Malbrain M., Chiumello D., Pelosi P., Bihari D., Ranieri M., Turco M., et al., Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med, 2005, 33, 315-322.

    31. Ejike, J.C., Outcomes of children with abdominal compartment syndrome.  Acta Clin Belg Suppl, 2007, 41-48.

    32. Cheatham M., Malbrain M., Abdominal perfusion pressure, in Abdominal compartment syndrome. Landes Bioscience: Georgetown, 2006, 22, 69-81.

    .          

    33.Deeren H., Dits H., Malbrain M., Correlation between intra-abdominal and intracranial pressure in non-traumatic brain injury. Intensive care med, 2005, 31, 1577-1581. 34. Stanford R. Intra-abdominal pressure monitoring. Available from UR: http://www.science direct.com

    35. Kohle Lee R., Intra-abdominal hypertension and abdominal compartment syndrome: A comprehensive overview. American critical care nursing, 2012, 32,19-31.

     

    36. Available from UR: http://wsacs.org/algorythms.php

     

    37. Available from URL: http://springlink.

Comparison of changes in intra-abdominal pressure in 0, 15 and 30 degrees head of bed position in patients hospitalized in special care departments of medical training centers in Rasht city in 2010-2019
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