The Effect of Prone Position Use Ventilator-Associated Pneumonia in Intensive Care Patients
- Conditions
- Intensive Care Unit Syndrome
- Interventions
- Other: practicing prone position
- Registration Number
- NCT05760716
- Lead Sponsor
- Istanbul Arel University
- Brief Summary
The aim of this experimental study was to investigate the effect of prone position use on ventilator values, blood gas and ventilator-associated pneumonia in intensive care unit patients. Between June 2021 and January 2022, 40 trials and 40 control patients were included in the intensive care units of two private hospitals and received mechanical ventilation support. The mechanical ventilator values, arterial blood gases and ventilator-related pneumonia conditions were evaluated and followed for at least 5 to 10 days just before the position was given by comparing the prone position (PP) and the patients were brought back into the supine position. The data were collected using 'Patient Follow-up Charts', 'Clinical Pulmonary Infection Score', 'Braden Pressure Half Risk Assessment' and 'Ramsey Sedation Scale' prepared in line with patient introduction form and evidence-based guidelines. In addition, life findings, cultural results and blood gas analyses were performed. Statistical analysis was performed using the 'NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA)' program. 'Descriptive statistics, parametric and nonparametric tests' were used to evaluate the data. The level of statistical signiation was considered 'p\<0.05'.
- Detailed Description
Patients hospitalized in intensive care units are intubated and taken to mechanical ventilation support due to reasons such as inability to maintain airway patency, increase in respiratory/myocardial workload, and insufficient gas exchange. One of the strategies used to increase the effectiveness of mechanical ventilation therapy is the prone position (PP) application. In order to increase lung capacity and improve oxygenation in acute lung failure, the prone position was first applied in mechanical ventilation in the 1970s. Studies have shown that the prone position is protective against preventing ventilator-induced lung damage, and it has been found to increase PaO2/FiO2 in 70% of intensive care patients with severe hypoxemia receiving MV support. The reduction of the pressure on the lungs and the more homogeneous lung perfusion are effective in protecting the lungs in patients with prone position. Prone positioning of intensive care patients; It includes the risk of serious complications such as endotracheal tube obstruction, unplanned extubations, tachy and bradyarrhythmias, loss of venous and arterial access, cardiac arrest and pressure ulcer development in anterior body surface areas.
Positioning is one of the practices that nurses use by using their professional knowledge and skills. The positive effects of the position given to the patients in the intensive care unit on treatment and care are stated. Nurses continue to play a key role in the follow-up and treatment of patients who are placed in the prone position under mechanical ventilation therapy, from the continuous evaluation of the patients to the implementation of care practices, to provide the best clinical results.
In this study, a randomized controlled experiment was planned to determine the effect of the prone position by evaluating the mechanical ventilator values, blood gas and ventilator-associated pneumonia status before the position is applied, during the position and after the patients are brought back to the supine position by comparing the groups with and without the prone position.
The aims of the research;
* How prone position affects ventilator mode values
* How the prone position affects blood gas results,
* To examine how prone position affects the rate of development of ventilator-associated pneumonia.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 80
- Being 18 years or older,
- Receiving respiratory support with a mechanical ventilator in the ICU,
- COVID 19 test negative,
- Consent by the first degree relative.
- Being under the age of 18,
- Receiving a diagnosis of VAP before admission to the ICU,
- Having a positive COVID 19 test,
- Presence of an obstacle to prone positioning (obesity, pregnancy, anterior chest wall surgery, advanced heart failure, etc.).
- Not giving consent to participate in the study by a first-degree relative
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Experiment Group practicing prone position * The prone position was positioned within the application steps. * The introductory characteristics form of the patients was filled in on the day the patient was included in the study. * Blood gas results and mechanical ventilator respiration indicators were followed up in the PP for 5-10 days and the changes were recorded in the tolerance hours. Arterial blood gas results, mechanical ventilator values, and ventilator-associated pneumonia status were monitored before the position was applied, during the position and after the patients were placed in the supine position by comparing the groups with and without the prone position. • Nursing intervention application steps for VAP were followed during the PP and the changes were recorded.
- Primary Outcome Measures
Name Time Method Patient Information Form 3-5 minutes demographics
Patient Follow-up Charts 15-20 minutes On vital signs
- Secondary Outcome Measures
Name Time Method Ramsey Sedation Scale 5-8 minutes The scale includes 1 to 6 points. 1 point: alert, anxious and/or restless, 2 points: alert, cooperative, oriented, calm, 3 points: sleeping, responding to verbal stimulus, 4 points: sleeping, moderately responding to painful stimulus , 5 points: sleeping, responding slowly to painful stimulus, 6 points: sleeping, no response to painful stimulus. The lowest score on the scale: 1: agitation, the highest score 6: deep sedation
Clinical Pulmonary Infection Score 3-5 minutes 'Clinical Pulmonary Infection Score' (CPES); It examines seven clinical parameters including leukocyte count, body temperature, endotracheal aspirate (ETA)/microbiological culture results, amount and character of tracheal secretion, Pa02/Fi02 ratio, and presence of pulmonary infiltration. A score of 6 or more suggests VIP.
Braden Pressure Sore Risk Assessment Scale 5-8 minutes The 'Braden Pressure Sore Risk Assessment Scale' (BBIRRS) consists of '6 sub-dimensions' and '19 risk assessments'. 'Perception of stimulus, activity, movement, humidity, nutrition items are between 1-4 points; friction-tear is evaluated between 1-3 points. As the scores obtained from the scale decrease, the risk of developing pressure ulcers increases, individuals with a scale score of '3-14' are considered to be at 'moderate' risk for the development of pressure sores, and those with a score of '15-16' are considered to be 'low risk'. The total score of the scale varies between '6-23' points.
Trial Locations
- Locations (1)
Istanbul University Cerrahpasa
🇹🇷Istanbul, Turkey