Abstract
The patient's position is important for ensuring patient comfort and preventing complications after thyroidectomy. This study was carried out to determine the effects of different degrees of head-of-bed elevation (HOBE) on the respiratory pattern and drainage following thyroidectomy and to provide suggestions for evidence-based clinical practice. The sample of this prospective, parallel arm, randomized controlled trial included 114 patients undergoing thyroidectomy in a university hospital in Turkey. The patients were randomly assigned (1:1:1) to supine 0° (baseline), 30° and 45° HOBE groups. Respiratory pattern including respiratory rate (RR), peripheral oxygen saturation (SpO2) and dyspnea, and drainage including amount of drainage and hematoma formation were evaluated at the 1rd, 2rd, 3rd and 4th hours following thyroidectomy. The majority of the patients (83.3%) were female and 84.2% had undergone total thyroidectomy. The mean RR (18.47, 95% CI=17.85-19.09) of the patients in the supine 30° HOBE group at the 1rd hour was significantly higher than that of the patients in the supine 0° group (17.32, 95% CI=16.88-17.76; p<0.05). There was no significant difference between the SpO2 values of the patients in the groups (p>0.05). The amount of drainage was significantly higher in the supine 0° group at the 2nd hour than that of the patients in the supine 45° HOBE group (5.92±5.18; 3.34±5.56 respectively; p<0.05). None of the patients in the groups had hematoma formation. While no patient in the supine 30° HOBE group had dyspnea, dyspnea occurred in 9 patients in the supine 0° group and in 3 patients in the supine 45° HOBE group. This study showed that different HOBE positions resulted in clinically insignificant changes on the RR and amount of drainage during the first 4 hours following thyroidectomy but did not affect SpO2 value.
Highlights
IntroductionThyroidectomy is a safe surgical procedure commonly used for the treatment of benign or malignant tumors, multinodular goiter and Graves disease.[1,2,3] because of the rich vascular structure of the thyroid gland, serious complications including hemorrhage, African Health SciencesAfrican Health Sciences Vol 20 Issue 1, March, 2020 hematoma and hematoma-related dyspnea can develop after thyroidectomy.[1,4,5,6] There are many studies in the literature addressing the causes, preventive interventions and treatment of complications such as hemorrhage, hematoma and respiratory problems in patients after thyroidectomy.[4,7,8,9,10,11,12,13] Some of these studies investigated the effects of positions such as semi-Fowler’s position, beach chair, partial trendelenburg or flat supine and valsalva maneuver on bleeding control and prevention of hematoma.[10,11,12] A previous study showed that patients should be placed in a semi-Fowler’s position to achieve bleeding control after thyroidectomy, but it did not examine efficacy of position on bleeding control.[10]
In the comparison between the groups, the mean respiratory rate (RR) (18.47; 95% confidence interval (CI), 17.85-19.09) of the patients in the supine 30° head-of-bed elevation (HOBE) group at 1st hour was significantly higher than that of the patients in the supine 0° group (17.32; 95% CI, 16.88-17.76) (p=0.01, Table 2)
Nine patients in the supine 0° group and 3 patients in the supine 45° HOBE group complained of dyspnea
Summary
Thyroidectomy is a safe surgical procedure commonly used for the treatment of benign or malignant tumors, multinodular goiter and Graves disease.[1,2,3] because of the rich vascular structure of the thyroid gland, serious complications including hemorrhage, African Health SciencesAfrican Health Sciences Vol 20 Issue 1, March, 2020 hematoma and hematoma-related dyspnea can develop after thyroidectomy.[1,4,5,6] There are many studies in the literature addressing the causes, preventive interventions and treatment of complications such as hemorrhage, hematoma and respiratory problems in patients after thyroidectomy.[4,7,8,9,10,11,12,13] Some of these studies investigated the effects of positions such as semi-Fowler’s position, beach chair, partial trendelenburg or flat supine and valsalva maneuver on bleeding control and prevention of hematoma.[10,11,12] A previous study showed that patients should be placed in a semi-Fowler’s position to achieve bleeding control after thyroidectomy, but it did not examine efficacy of position on bleeding control.[10]. Objectives: This study was carried out to determine the effects of different degrees of head-of-bed elevation (HOBE) on the respiratory pattern and drainage following thyroidectomy and to provide suggestions for evidence-based clinical practice. The amount of drainage was significantly higher in the supine 0° group at the 2nd hour than that of the patients in the supine 45° HOBE group (5.92±5.18; 3.34±5.56 respectively; p
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