Effects of Therapeutic Approaches on Intubation Response, Agitation Behavior, and Extubation Time İn Patients Undergoing Open Heart Surgery
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Bezmialem Vakif University
- Enrollment
- 30
- Locations
- 1
- Primary Endpoint
- Sociodemographic information form
Study Overview
Brief Summary
This study was conducted to understand how training given to patients before and after open-heart surgery affects their reactions during intubation (when a breathing tube is inserted), their agitation levels, and the time it takes to remove the breathing tube.
Study Design
The research followed a quasi-experimental design, meaning patients were divided into two groups:
Experimental Group - Received special training before and after surgery. Control Group - Received standard hospital care without additional training. Key Variables Independent Variable (What was changed): The training given before and after surgery.
Dependent Variables (What was measured):
Patient reactions during intubation Agitation levels Time taken to remove the breathing tube Study Hypotheses Patients who received the training would show different reactions compared to those who did not.
1.1. The trained group would show fewer negative reactions during intubation. Patients who received the training would have different agitation levels compared to the control group.
2.1. The trained group would be less agitated. The time taken to remove the breathing tube would be different between the two groups.
3.1. The trained group would have their breathing tube removed faster. Where and When Was the Study Conducted? The research took place at Bezmialem Vakif University Hospital in Istanbul in the cardiovascular surgery department, between October 10, 2022 - January 7, 2023.
Participants The study initially considered 123 patients who had undergone open-heart surgery during this period.
Patients were selected based on certain health conditions and criteria (age, no chronic respiratory disease, type of surgery, etc.).
After applying these criteria, 30 patients (15 in each group) were included in the final study.
How Were Patients Selected? To ensure fairness, patients were randomly assigned to either the experimental or control group.
A computer-generated random list was used to assign them. Who Was Included in the Study? Patients who had Coronary Artery Bypass (CABG), Aortic Valve Replacement (AVR), or Mitral Valve Replacement (MVR) surgery.
Patients aged 45-70 years old. Who Was Excluded? Patients with chronic respiratory disease (as it could affect intubation time). Patients who had previous open-heart surgery (as prior experience could influence their reaction).
Patients who did not speak Turkish or had cognitive issues. Patients with severe psychiatric conditions. Data Collection & Training Process
Before the surgery:
Patients were asked about their age, gender, smoking habits, medical history, and other factors.
Their anxiety levels were measured using a scale from 0 to 10 (0 = No anxiety, 10 = Extreme anxiety).
Training for the experimental group:
A special 40-50 minute training session was given a day before surgery. The training included breathing techniques, relaxation methods, and information about what to expect during recovery.
Family members were also involved.
After the surgery:
Patients were sedated as part of hospital protocol and then observed when they first woke up in the Intensive Care Unit (ICU).
The trained group received additional therapeutic communication techniques when they first woke up to help them stay calm.
The control group received only standard hospital care. Four hours after waking up, all patients were evaluated for their agitation levels and reactions to intubation.
How Were Reactions Measured? Richmond Agitation Sedation Scale (RASS ) - This measured how restless or calm the patient was.
Observation of Intubation Reactions - The research team noted behaviors such as:
Trying to pull out the breathing tube Biting the tube Facial expressions (like frowning or grimacing) Grabbing bed sheets Moving legs restlessly Breathing in sync with the ventilator Each behavior was scored from 0 (Not observed) to 4 (Strongly observed). A higher score meant the patient was more uncomfortable with intubation.
Results General reactions to intubation (measured with a scale) were similar in both groups.
However, when specific behaviors were examined, the control group had more visible distress:
More frowning and wrinkled facial expressions (p=0.030). More grabbing of bed sheets (p=0.013). There was no significant difference in agitation levels between the two groups. The time taken to remove the breathing tube was also not significantly different between the two groups.
Conclusion The special pre- and post-surgery training helped patients remain more comfortable during intubation, reducing visible signs of distress.
However, the training did not significantly impact overall agitation levels or the time needed to remove the breathing tube.
This suggests that therapeutic communication techniques may improve patient comfort but do not necessarily speed up the recovery process.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Supportive Care
- Masking
- Single (Participant)
Eligibility Criteria
- Ages
- 45 Years to 70 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Coronary Artery Bypass Graft, Aortic Valve Replacement, Mitral Valve Replacement having undergone one of these operations
- •No Chronic Respiratory Disease
Exclusion Criteria
- •Aortic Valve Replacement and Mitral Valve Replacement performed together
- •Use of a method other than median sternotomy
- •Redo coronary bypass surgery
- •Illiteracy and not knowing Turkish
- •Being under psychiatric treatment and follow-up recently (last 1 year)
Arms & Interventions
Trained group
Pre-Surgery:
Patients received a special training including therapeutic communication techniques.
The training was prepared by reviewing the literature and integrated into hospital practices.
One day before surgery, the patient and patient's relatives were trained in a session lasting 40-50 minutes.
All stages of the training were monitored using the "Preoperative Training Checklist ".
Postoperative:
When the patients were taken to the intensive care unit, sedation was applied again at the first awakening according to the hospital protocol.
After the effect of sedation wore off and the patient was conscious but still intubated, therapeutic interventions were performed.
This process was done with the "Postoperative Education Checklist " prepared based on the literature.
Data Collection:
4 hours after the patients woke up, by the researcher: RASS (Richmond Agitation Sedation Scale) was applied. Intubation Reactions Form was filled. The time to come out of intubation was recorded.
Intervention: THERAPEUTIC APPROACH TRAINING (Behavioral)
Non-training group
Preoperative No special training was given to the control group. Patients were only subjected to routine hospital procedures.
Postoperative:
Standard hospital protocol was applied when the patients were admitted to the intensive care unit.
Sedation was applied again, but no additional therapeutic intervention was performed.
Patients received only routine nursing care.
Data Collection:
4 hours after patients woke up, by the investigator: RASS (Richmond Agitation Sedation Scale) was administered. Intubation Reactions Form was completed. The time to come out of intubation was recorded.
Outcomes
Primary Outcomes
Sociodemographic information form
Time Frame: From the data obtained from the enrollment of the first participant until week 12 Before the operation
The demographic characteristics of the patients such as age, gender, education level, chronic diseases, history of surgery, height and weight, smoking and alcohol use, psychiatric treatment and follow-up status were evaluated with a 13-item form created by the researchers by using the literature.
Numerical anxiety scale
Time Frame: From the data obtained from the enrollment of the first participant until week 12 Before the operation
The Numerical Anxiety scale has a starting point of "0" or "no anxiety" and an ending point of '10' or "severe anxiety" (horizontal line was used in this study). The patient chooses the number from the scale that best describes him/her. Preoperative and postoperative anxiety is higher in patients undergoing open heart surgery compared to other surgeries. Anxiety level is a factor that may lead to increased agitation and patient non-compliance with mechanical ventilator. For this reason, anxiety level was used as a control variable to measure the effectiveness of the intervention to be applied to the experimental and control groups and to ensure the homogeneity of the experimental and control groups. The results of the scale were evaluated on the arithmetic mean.
Secondary Outcomes
No secondary outcomes reported
Investigators
Nareg Dogan
Associate Prof
Bezmialem Vakif University