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Mostafa Alavi, Tooraj Babaee, Mahshid Ghadrdoost, Alireza Azad,
Volume 4, Issue 4 (3-2016)
Abstract
Abstract Aim.This study aimed to compare pulse pressure variation (PPV) with central venous pressure (CVP) in checking out and optimizing fluid volume in mechanically ventilated patients admitted to intensive care unit after cardiac surgery. Background.In clinical area, assessment of body fluid and determination of the intravascular volume after major surgeries such as heart surgery is a significant challenge. The initial purpose of intravascular volume assessment in patients with hemodynamic instability is to determine whether they would benefit from fluid administration or not. Method. In the present study a prospective descriptive-analytic design was used. Thirty mechanically ventilated patients admitted to intensive care units of Rajaee Heart Center, Tehran, Iran, were recruited in the study after cardiac surgery based on inclusion criteria. Data collection tools included demographic and clinical data sheets. Hemodynamic parameters such as CVP, systolic and diastolic pressures (for calculating pulse pressure and its variation) were recorded by bedside monitoring. Cardiac Index (CI) was measured by non invasive continuous cardiac output monitoring (NICCOMO) system. Data were analyzed in SPSS version 20, using statistical tests. Findings. The mean changes of CVP, before and five minutes after fluid administration, were significantly different (10.10±6.01 mmHg and 12.37±6.34 mmHg, respectively, p=0.015). The mean changes in arterial pulse pressure, before and five minutes after fluid administration, were significantly different (16.94±8.32 mmHg and 12.77±4.02 mmHg, respectively, P=0.005). At the cut point 2.8 lit/min/m2 for CI, the sensitivity and specificity values for PPV>13%, were 0.71 and 0.61, respectively. Also, at the same cut point, the sensitivity and specificity values for CVP<5mmHg, were 0.11 and 0.84, respectively. These findings suggest a higher diagnostic power of PPV compared to CVP to assess fluid volume. Conclusion.It seems that in the mechanically ventilated patients after heart surgery, PPV dynamic index is preferred to CVP static index to evaluate and maintain fluid volume.
Hosein Feizi, Hiwa Mohammadi, Ahmadreza Yazdannik, Mohsen Mir Mohammad Sadeghi, Pariya Zamani,
Volume 5, Issue 3 (12-2016)
Abstract
Abstract
Aim. The aim of this study was to examine the effect of incentive spirometry and deep breathing exercises on arterial blood gas parameters after coronary artery bypass graft (CABG) surgery.
Background. After CABG, pulmonary complications and oxygenation disorders are common and play an important role in post-operative mortality and morbidity. The different methods are being used for improvement of pulmonary function and oxygenation after CABG.
Method. In this clinical trial study, 75 patients who were candidate for CABG surgery were recruited and randomly allocated to two intervention groups (incentive spirometry group and deep breathing exercise group) and control group. The groups were compared in terms of arterial blood gas parameters (PaO2, PaCO2 and SaO2) before surgery, and on the first day, the second day, and the third day after surgery.
Findings. The study findings showed that in the third postoperative day, there was a statistically significant difference between intervention groups and control group in terms of the mean of arterial blood gas parameters (PaO2, PaCO2 and SaO2).
Conclusion. Incentive spirometry and deep breathing exercise are both significantly effective on improvement of arterial blood gas parameters (PaO2, PaCO2 and SaO2).
Fatemeh Asgari, Frank Kargar, Farzaneh Fotouhi, Shiva Khaleghparast,
Volume 8, Issue 1 (3-2019)
Abstract
Abstract
Aim. This study aimed at examining the effect of preoperative fluid therapy on kidney function in patients undergoing heart surgery.
Background. As one of surgery complications, kidney failure occurs with oliguria and rise in creatinine. Decreased heart output leads to reduction in renal perfusion. Acute renal failure is associated with increase in morbidity, mortality and high medical treatment cost. Various studies has indicated an increase in postoperative mortality rate when complications of acute renal failure superimpose the situation. One of the best strategies for kidney protection is optimizing preoperative hemodynamics and fluid therapy.
Method. In this clinical trial study, 107 patients were recruited based on inclusion criteria and randomly allocated to experimental (n=54) and control (n=53) group. Patients in experimental group received Half- Saline, 1cc/kg/hr, during 12 hours before surgery. Patients in control group started as being NPO, 8 hours before the surgery. Creatinine level, BUN, and 24-hours urine output were measured and recorded during two days after surgery. Data were analyzed in SPSS V.22 using descriptive and inferential statistics.
Findings. The groups didn't differ in terms of age, gender, weight, and ejection fraction. There was no statistically significant difference between experimental and control group in terms of creatinine changes during the preoperative day and the first and the second day after surgery. Also, there was no statistically significant difference between groups in BUN on the first and second days after surgery. The urine output of the experimental group was greater than control group on first and second days after operation, but the difference was not significant. The duration of ICU stay were similar in both groups. There were recorded two deaths in control group while there was no death in experimental group.
Conclusion. It was concluded that preoperative fluid therapy has no short-term effect on kidney function. It is recommended to examine the effect of fluid therapy on kidney function in longer periods.
Fateme Falamarzi, Shiva Khaleghparast, Mohammad Zia Totonchi , Mahmood Sheikh Fathollahi,
Volume 9, Issue 1 (3-2020)
Abstract
Abstract
Aim. This study was conducted to examine the effect of using Burn weaning checklist on the duration of mechanical ventilation and hemodynamic criteria in patients undergoing adult open heart surgery.
Background. Mechanical ventilation is an adjunct or alternative to spontaneous breathing. Due to the proximity of the circulatory and pulmonary systems, the balance of the mechanical ventilation system and the human cardiovascular system is complex, and its weaning must be planned.
Method. This randomized clinical trial study was performed on 80 patients admitted for open heart cardiopulmonary bypass surgery. After random assignment, in the control group, the weaning process was performed according to the routines by a physician, and in the experimental group, the weaning was performed by a Burn checklist by a physician and a nurse. Hemodynamic criteria (first and second hours upon arrival, first and second hours during weaning, first and second hours after weaning) and duration of mechanical ventilation were recorded and compared between experimental and control group. Data were analyzed in SPSS software version 22 using two-way repeated measures ANOVA.
Findings. The mean intubation duration in the experimental group (7.50±1.86 hours) was significantly less than the control group (11.30±3.39 hours) (P≤0.0001). The interaction between group and time for variables diastolic blood pressure (P=0.002), pulse pressure (P=0.003) and heart rate (P≤0.0001) was statistically significant.
Conclusion. The use of the Burn assessment checklist reduces the duration of weaning process in patients after adult open heart surgery. It also helps balancing hemodynamic criteria.
Mehdi Shamali-Ahmadabadi, Leila Issa-Nejad, Ali-Akbar Vaezi,
Volume 10, Issue 1 (3-2021)
Abstract
Abstract
Aim. The present study was performed to examine the effect of virtual reality therapy training on Covid-19 anxiety in patients with hypertension in Corona pandemic.
Background. In addition to numerous physical problems, Covid-19 has had many psychological consequences such as stress and anxiety, especially in the community of chronic patients, including patients with hypertension. Therefore, appropriate interventions to reduce Covid-19 anxiety in patients with hypertension are essential.
Method. The present study was a quasi-experimental with a pretest-posttest design and a control group. The statistical population of the study consisted of all patients with hypertension referred to Ardakan Heart Clinic, Yazd, Iran. Using the available sampling method and according to the inclusion and exclusion criteria, 60 people were selected and randomly allocated to experimental (n=30) and control (n=30) group. Both groups completed the Alipour’s et al. (1398) Covid-19 questionnaire in the pre-test and post-test stages. The experimental group received the training in 6 sessions of one hour duration. Then, both groups completed the research questionnaires again in the post-test stage. Data were analyzed in SPSS version 26 using descriptive and inferential statistics.
Findings. After intervention, there was a statistically significant difference between the experimental and control group in terms of the mean scores of Covid-19 anxiety (P≤0.0001, F=110.807), psychological dimension of Covid-19 anxiety (P≤0.0001, F=78.30), and the physical dimension of Covid-19 anxiety (P≤0.0001, F=94.27).
Conclusion. Implementing virtual education intervention program with the content of reality therapy can reduce anxiety and its psychological and physical dimensions in people with hypertension.
Mohammad Montaseri, Dr. Fatemeh Bahramnezhad,
Volume 12, Issue 1 (3-2023)
Abstract
Abstract
Aim. This study was conducted with the aim of providing care solutions to manage the hemodynamic status of potential donors with brain death.
Background. Currently, organ transplantation is the treatment of choice for complete organ failure. The results of studies have shown that a significant percentage of potential donors with brain death organs are not usable for transplantation due to hemodynamic instability. Therefore, hemodynamic management in this category of donors plays an essential role in the donation process. Despite the studies, there are no strong evidences and recommendations about the management of hemodynamic stability of these patients. Therefore, in this review, evidence-based solutions have been tried to maintain the hemodynamic stability of these donors.
Method. In this review study, with library search and search in databases PubMed, Scopus, Web of Science, SID, and MagIran with the keywords organ donor management, brain death, hemodynamic care, organ donor, deceased donor, hemodynamic management, donation after neurological death, and cardiovascular management published in the period from 2009 to 2024. In addition, the Google Scholar search engine was also explored. A total of 20 articles were included in the literature review.
Findings. Maintaining proper organ perfusion and identifying clinical conditions that can be effectively treated are among the most important goals of hemodynamic management of these donors, and hemodynamic monitoring, serum therapy, use of cardiac drugs, and hormone therapy are among the most important. There are also studies that recommend serial echocardiography to identify reversible clinical conditions.
Conclusion. The high demand for organ transplantation, and despite the high number of brain deaths and sometimes consent for transplantation, only a small percentage of these people's organs are successfully transplanted. In order to preserve the transplanted organs, it is recommended to take proper and basic care of the patients with brain death. It is necessary for nurses, especially nurses in the intensive care unit, to be very careful in caring for patients with potential brain death.
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