A Study to Assess the Effect of Therapeutic Positions on Hemodynamic Parameters among Critically Ill Patients in the Intensive Care Unit at Sri Ramachandra Medical Centre

A Mercy Anchala

doi:10.4172/2167-1168.1000348

Abstract

Positioning is one of the most frequently performed nursing activities in the critical care, often providing a central pivotal focus for planning other nursing activities. Currently, the concept of therapeutic positioning is emerging in trauma and critical care with the adaptation of research based positioning strategies designed to enhance or promote physiologic stability and tolerance of nursing and medical treatments. The study was aimed to determine the effect of therapeutic positions on hemodynamic parameters among critically ill patients. Experimental pre-test – post-test design was used. Samples were critically ill patients who got admitted in the C4 multi-disciplinary intensive care unit of Sri Ramachandra Medical Centre. Simple random sampling was used to select 40 samples. Hemodynamic parameters such as heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, oxygen saturation, mean arterial pressure and the background variables of critically ill patients were studied together. Positioned the patients on various therapeutic positions for every two hours by following turning schedule such as left lateral, supine, right lateral, supine and semi fowler’s position was carried out for the study group patients, whereas the control group received the routine care. Hemodynamic parameters were assessed before and after the positioning for both the groups for three days. There was a significant difference in systolic blood pressure in left lateral position at (t value 3.317) p<0.01 and oxygen saturation in semi fowler’s position (t value 9.211) p<0.001. This study has attempted to identify the changes in hemodynamic parameters among critically ill patients while following turning schedule. The study shows that there was a significant difference in systolic blood pressure in left lateral position and oxygen saturation in semi fowler’s position. Therapeutic positions based on turning schedule have a significant role in maintaining the hemodynamic parameters and preventing complications.

Highlights

Hemodynamic instability is the main reason why critically ill patients stay in the supine position for extended periods
To assess the hemodynamic parameters among critically ill patients who received therapeutic positions for three days, assessment data of hemodynamic parameters such as heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and oxygen saturation were measured from monitors before and after the positioning
The findings revealed that there was a significant increase in oxygen saturation in semi fowler’s position and there was a significant difference in blood pressure in left lateral position

Summary

Introduction

Hemodynamic instability is the main reason why critically ill patients stay in the supine position for extended periods. After a change in the body’s gravitational plane, the cardiovascular system tries to adjust in two ways:. An inner ear or vestibular response affects the cardiovascular system. Even during sleep, approximately every 12 min. A variety of sensory cues prompt a change in body position. These sensory cues prevent detrimental effects of prolonged periods of immobility. Individuals who have neurological impairments must rely on others to reposition them to prevent hazards of immobility. Nurses use clinical judgment based on physiological and scientific evidence to position critically ill patients to prevent complications of immobility and to achieve optimal patient outcomes. Therapeutic positioning in stationary positions is done to optimize ventilation and perfusion and to promote effective pulmonary gas exchange

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