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Abstract: Purpose: The aim of this randomized controlled study was to determine the effect of semielevated side‐lying (ESL) and semielevated supine (ESU) positions, which are used to bottle‐feed preterm infants, on their physiological characteristics and feeding performance. Design and Methods: The sample consisted of preterm infants who were born in the 31st gestational week and below, and met the inclusion criteria. A randomization was provided in the sample group with a total of 80 infants including 38 infants in the ESL (experimental) group and 42 infants in the ESU (control) group. Both groups were compared in terms of their SpO2 values, heart rates, and feeding performances before, during, and after the feeding. The data were obtained by using a form for infant descriptive characteristics, feeding follow‐up form, a Masimo Radical‐7 pulse oximeter device, and a video camera. Results: It was determined that the infants in the ESL group had statistically significantly higher SpO2 values (ESL: 96.77 ± 2.51; ESU: 93.48 ± 5.63) and lower heart rates (ESL: 155.87 ± 11.18; ESU: 164.35 ± 6.00) during the feeding compared to the infants in the ESU group (p < .05). Besides, oxygen saturation levels of the infants in the ESU group decreased more (p < .01) and their heart rates increased more (p < .05) during the feeding than those obtained before the feeding compared to the infants in the ESL group. Practice Implications: The ESL position has a more positive effect on oxygen saturation and heart rate of infants and it is more effective in providing a physiological stabilization during the feeding, compared to the ESU position. According to these results, the ESL position can be recommended for preterm feeding. [ABSTRACT FROM AUTHOR]

The aim of the current study was to compare the changes in polysomnographic indices and serum levels of C-reactive protein (CRP), cystatin C, tumor necrosis factor-a (TNF-α), and intercellular adhesion molecule-1 (ICAM-1) in patients with obstructive sleep apnea (OSA) who were treated surgically via a uvulopalatal lap (UPF) technique. Twenty-five patients (14 men, 11 women), average age 46.2 ± 9.3 years, who underwent UPF surgery were included in this study. Serum biochemical analyses and polysomnographic examinations were performed before and 6 months after the surgery. Pre- and postoperative values of apnea hypopnea index (AHI), oxygen desaturation index (ODI), and minimum oxygen concentrations, as well as serum levels of CRP, cystatin C, TNF-α, and ICAM-1 were compared. Comparison of variables before and after UPF surgery demonstrated that AHI (p = 0.001), ODI (p < 0.001) and oxygen saturation (p < 0.001) were significantly improved. In addition, serum levels of CRP (p = 0.036), cystatin C (p = 0.005), TNF-a (p < 0.001), and ICAM-1 (p < 0.001) were significantly reduced 6 months after surgery. Our results suggest that UPF is an effective surgical method that alleviates the severity of OSA. Moreover, it may have the potential to prevent the development of atherosclerosis by attenuating the inflammatory process induced by activation of inflammatory mediators such as CRP, TNF-α, ICAM-1, and cystatin C. [ABSTRACT FROM AUTHOR]

BACKGROUND: Asymmetric dimethylarginine and ischemia-modified albumin are new biomarkers that are used for evaluation of ischemia and oxidative stress. The present study aimed to investigate whether serum levels of asymmetric dimethylarginine and ischemia-modified albumin are altered in subjects with obstructive sleep apnea (OSA). METHODS: A cross-sectional, clinical study was implemented on data derived from 79 subjects who underwent polysomnography. Cases were allocated into 3 groups with respect to polysomnography results: Group 1 consisted of 22 subjects without apnea, whereas Group 2 comprised 29 subjects with mild to moderate OSA, and Group 3 included 28 subjects with severe OSA. These 3 groups were compared in terms of demographic datas and polysomnographic parameters, serum levels of asymmetric dimethylarginine and ischemia-modified albumin. RESULTS: Serum levels of ischemia-modified albumin were significantly higher in Groups 2 and 3 (P = .001). Mean ... of Group 3 was notably lower than that of Groups 1 and 2 (P < .001), whereas times for ... <90% were statistically significantly different from each other in all 3 groups (P < .001). Serum levels of asymmetric dimethylarginine in Group 3 were notably higher than those in Group 1 (P = .027). Levels of ischemia-modified albumin were correlated positively with AHI and time ... <90% values (P = .008 and P < .001, respectively). CONCLUSIONS: Ischemia-modified albumin and asymmetric dimethylarginine were significantly higher in subjects with OSA. Furthermore, ischemia-modified albumin was independently associated with severity of OSA defined by AHI and severity of oxygen desaturation. [ABSTRACT FROM AUTHOR]

Aims and objectives The research was conducted to evaluate oxygen saturation values measured in healthy individuals in different body positions. Background Changes in position affect ventilation-perfusion rates, oxygen transport and lung volume in normal lungs. There have been few studies and not enough information about which positioning of a healthy individual can increase oxygenation. Design A descriptive study. Methods A sample of 103 healthy individuals with no chronic disease, anaemia or pain was included in the research. Individuals were positioned in five different positions: sitting upright, supine position, prone position, lying on the left side and lying on the right side. Oxygen saturation and pulse rates were then measured and recorded after the individuals held each position for ten minutes. Results It was found that the average oxygen saturation value when measured while sitting in an upright position in a chair was significantly higher than that measured when the individual was lying on the right or left side of the body. Oxygen saturation values measured in the five different body positions were significantly higher in women, in individuals below the age of 35, in those with Body Mass Indexes of below 25 kg/m2, and in nonsmokers. Conclusion All of the oxygen saturation values measured in the five different body positions were in the normal range. Although oxygen saturation values were within the normal range in the five different body positions, post hoc analysis showed that the best oxygenation was in the 'sitting upright' position while the lowest oxygenation was in the supine position. Relevance to clinical practice Based on the results of this research, it can be concluded that the differences among oxygen saturation values according to the different body positions were statistically significant. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Endotracheal suctioning has been identified as a painful procedure for critically ill patients. Aim To determine the effect of music therapy on pain intensity, sedation level and physiological parameters during endotracheal suctioning of mechanically ventilated patients in cardiovascular surgery intensive care unit (ICU). Design Experimental survey. Methods The study was conducted between May 2010 and June 2013 in Ordu Medical Park Hospital Cardiovascular Surgery Intensive Care Unit. The study sample consisted of 66 patients (33 experimental and 33 control) who complied with the criteria of inclusion for the study. Data was collected using the 'Patient Information Form', 'Critical-Care Pain Observation Tool', 'Ramsay Sedation Scale' and 'Form of Physiological Parameters'. Results The mean scores of the Ramsay Sedation Scale during endotracheal aspiration were respectively 1·88 and 1·55 in the experimental and control group and the difference between the groups was statistically significant ( p = 0·003). The mean score of Critical-Care Pain Observation Tool during endotracheal suctioning in the experimental group was found to be lower statistically than those of the control group ( p < 0·001). There were no significant differences before, during and 20 min after suctioning between the two groups with regard to systolic blood pressure, diastolic blood pressure, heart rate and oxygen saturation ( p > 0·05). Conclusions The results of this study implies that music therapy can be effective practice for nurses attempting to reduce patients' pain and control sedation level in patients on mechanical ventilators during endotracheal suctioning. Relevance to clinical practice It is recommended that music therapy should be added to the routine nursing care for mechanically ventilated patients. [ABSTRACT FROM AUTHOR]

Background Delivery of supplemental oxygen is the initial vital management of hypoxemic acute lower respiratory infection (HALRI). Oxygen delivery systems include low-flow and high-flow devices. In high-flow devices such as the Venturi mask, a constant mixture of oxygen is delivered. As a result, increased rate of breathing does not affect the concentration of oxygen delivered. In this study, we compared the efficacy of oxygen masks and Venturi masks in the management of hypoxemia in pediatric patients. Methods A total of 65 children, aged 3-36 months, diagnosed with HALRI, were enrolled. Patients were allocated into groups, via simple alternate randomization, to receive oxygen through an oxygen mask or through a Venturi mask. Respiratory rate, heart rate, retraction, blood gas parameters, oxygen saturation, length of hospitalization, and oxygenation were recorded before and after oxygen treatment. Results After 24 h of treatment, respiratory rate was significantly lower among patients in the Venturi mask group compared with the oxygen mask group. Duration of supplemental oxygen and length of hospitalization were significantly lower in the Venturi mask group compared with the oxygen mask group. Conclusion In both groups, there was marked improvement in all measured parameters following introduction of supplemental oxygen. Oxygen was delivered more efficiently, however, by high-flow systems. The Venturi mask may decrease the total duration of oxygen usage time as well as the length of hospitalization among young children with HALRI through rapid symptom resolution. [ABSTRACT FROM AUTHOR]

Aims This study was carried out to determine the effects of open and closed suction systems on haemodynamic parameters of the patients who underwent open heart surgery. Background Nurses should work meticulously and carefully as many complications may develop if the method used to perform suctioning is not appropriate. Design The quasi-experimental study design was used. Method The study sample comprised 120 patients who underwent open heart surgery in the cardiovascular surgery intensive care unit of a state hospital in Turkey. Haemodynamic parameters were determined just before, right after, at the 5th and 15th minute after suctioning. The data were evaluated with the One-Way Analysis of Variance ( ANOVA) for Repeated Measures, independent t-test and Bonferroni's test for further analysis (post hoc). Results The difference between heart rate ( HR) and mean blood pressure, mean PaO2 and PaCO2, SaO2 and pH values measured before, right after and at the 5th and 15th minute after suctioning was found to be significant in patients who underwent the open suctioning procedure. It was determined that the difference between mean PaO2 values was not significant and that SaO2 versus SpO2 values increased in patients who underwent the closed suctioning procedure. When the open and closed suction systems were compared, statistically significant difference was determined in terms of MAP, SpO2. Conclusion It was determined that HR, arterial blood pressure and arterial blood gases of the patients who underwent open heart surgery were negatively affected by the open suction system but did not increase significantly as soon as suctioning was over during the closed suctioning procedure. The data obtained indicate that closed system suctioning, compared with open system suctioning, can be used safely on this patient group. Relevance to clinical practice The closed suction system is recommended since it contributes to the enhancement of patient safety and the quality of nursing care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sleep disorders and nocturnal hypoxia are common in patients with cerebrovascular disease. Sleep-disordered breathing is associated with a poor functional outcome in stroke patients. OBJECTIVE: We investigated the relationship between nocturnal hypoxia and functional outcome in the rehabilitation phase of stroke patients. METHODS: Thirty patients with stroke and 20 controls were included. Functional status was evaluated with the Functional Independence Measure (FIM). Pulse oximetry was performed overnight from 21.00 h to 07.00 h. Baseline awake oxygen saturation, nocturnal oxygen saturation, the lowest nocturnal oxygen saturation, and the >4% Oxygen Desaturation Index (ODI) were calculated. RESULTS: The mean oxygen saturation measurements were not significantly different among the groups (p > 0.05). There was no significant relationship between the FIM scores and the oxygen saturation measurements of the stroke patients (p > 0.05). The baseline oxygen saturation in patients with disease duration of 3 months or less was 94.67, and it was 96.56 (p = 0.016) in those with disease duration of more than 3 months. CONCLUSION: This study showed that nocturnal oxygen saturation was not associated with functional outcome in the rehabilitation phase of stroke patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The effects of long term oxygen therapy (LTOT) on the quality of life and survival of chronic obstructive pulmonary disease (COPD) patients with respiratory failure, and the compliance to LTOT were investigated in this prospective cohort study. MATERIAL AND METHODS: Fifty-four COPD patients, in whom LTOT was indicated, were recruited to the study between February 2006 and July 2007. Patients received two follow-up visits at 5 and 10 months, and were followed for approximately 19 months. Echocardiography was performed and the dyspnoea score (Medical Research Council, MRC) and St. George Respiratory Questionnaire (SGRQ) were applied at the initial and follow-up visits. In addition, the duration of oxygen treatment and indication for maintenance of LTOT was evaluated. RESULTS: The mean age of the patients was 64 years; 7 were female and 47 were male. The mean duration of oxygen treatment prior to the first and second follow-up visits were 9.8 and 10.6 hours, respectively. The percentage of effective LTOT use (1 5 hours or more) at the first and second follow-up visits was 31 % and 46%, respectively. There was no statistically significant difference in the survival of patients who were using effective and ineffective oxygen treatment. The mean baseline pulmonary arterial pressure showed a significant decrease from 50 mmHg at baseline to 40mmHg at the second follow-up visit in patients using effective LTOT (p=0.01). The symptom scores of SGRQ at the second follow-up visit were higher than the baseline values (p=0.005). CONCLUSION: In the present study, patient compliance to LTOT was low. Although there was a decrease in pulmonary artery pressure, and an improvement in the life quality of patients as a result of LTOT use, LTOT had no effect on the survival of patients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the changes in arterial oxygénation and vital parameters by applying 10cm H2O positive end-expiratory pressure (PEEP) to patients undergoing lumbar spine surgery in the prone position. Patients and Method: According to The American Society of Anesthesiologists (ASA) status I-II, 40 patients, scheduled for lumbar discectomy in the prone position were enrolled in the study. During the anesthesia induction and after intubation they were ventilated with intermittent positive pressure ventilation (IPPV) mode, 60%N2O-40%O2, 4L.min-1 flow and 0.7-1.0 minumum alveolar concentration (MAC) sevoflurane. The patients were randomized into 2 groups. PEEP value was set at 0 cm H20 in PEEP 0 group and at 10 cm H2O in PEEP 10 group. Respiratory rate 10/min, inspiration-expiration ratio 1:2 and tidal volume 8ml.kg"' were kept constant. Blood gas samples were obtained 10 min after induction and 15-30-45-60-75-90 min after prone positioning. Vital parameters, dynamic compliance and side effects were recorded. Results: Mean blood pressure was statistically low in PEEP 10 group at the prone positioning, compared to the other periods (p<0.05). Pulse rate in both groups was significantly low during the prone period compared to other periods (p<0.05). PaO2 and compliance were statistically high in PEEP 10 group at the prone position as compared to the PEEP 0 group (p<0.05). Conclusion: In our opinion, applying 10 cm H2O PEEP to patients undergoing spine surgery in the prone position is a beneficial implementation [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to evaluate the effects of exogenous surfactant on respiratory indices in term infants with respiratory failure. Methods: Consecutive 18 mechanically ventilated term infants, who received a single dose of exogenous surfactant were retrospectively included into the study. The respiratory outcome of surfactant rescue therapy was evaluated by comparing respiratory indices before and six hours after surfactant administration. Findings: Median oxygenation index (OI), mean alveolar pressure (MAP) and fraction of inspired oxygen (FiO2) values were significantly decreased (P<0.001); median arterial oxygen partial pressure (PaO2), arterial oxygen saturation (SaO2) and PaO2/FiO2 values were significantly increased six hours after surfactant treatment (P<0.001). Conclusion: Rescue therapy with surfactant was found to be effective in the improvement of early respiratory indices in term infants with respiratory failure. [ABSTRACT FROM AUTHOR]

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Aim: The aim of this study was to evaluate the indications, effectiveness and complications of high-frequency oscillatory ventilation (HFOV) in infants who were ventilated with HFOV in the last three years. Material and Method: The study was conducted in the neonatal intensive care unit of Mersin University Hospital. Medical files of 40 infants who were ventilated by HFOV between January 2008 and December 2010 were evaluated retrospectively. The babies who died within the first four hours of HFOV were excluded. Conventional mechanical ventilation modes, duration of ventilation, complications, indications for HFOV, blood gases and changes in ventilator settings during HFOV were recorded. Chi-square test was used for the statistical analysis of the data. The significance level for all data was set at p<0.05. Results: Hemoglobin-oxygen saturation and pH significantly increased after one and four hours of HFOV application, respectively. pCO2, FiO2 and amplitude values significantly decreased after one hour of HFOV application (p< 0,05). The mean values of peak inspiratory pressure and mean airway pressure were 25,9 and 10.6 cm H2O respectively at the time of switching from conventional ventilation to HFOV. Conclusions: The study revealed that more than half of the babies who had pneumothorax or needed more than 25 cm H2O of peak inspiratory pressure to maintain tidal volume but failed to improve blood gases during conventional mechanical ventilation could be saved and discharged by using HFOV. (Turk Arch Ped 2012; 47: 17-21) [ABSTRACT FROM AUTHOR]

Aim and objective. This research aimed to assess the effect of giving pacifiers to premature infants and making them listen to lullabies on the transition period to total oral feeding, their sucking success and their vital signs (peak heart rate, respiration rate and oxygen saturation). Background. It is very important that preterm infants start oral feeding as soon as possible to survive and get healthy quickly. Previous studies have shown that by using some external stimuli, premature babies can move to oral feeding at an earlier period than 34th gestational week, have increased daily weight gain and be discharged from hospital earlier. Design. In this quasi-experimental and prospective study, 90 premature infants were studied with 30 premature infants allocated to each of pacifier, lullaby and control groups. Method. The research was conducted at a neonatal intensive care clinic and premature unit of a university hospital in the east of Turkey between December 2007-January 2009. The data were collected through demographic information form for premature infants, the LATCH Breastfeeding Charting System and patient monitoring. Results. We found that the group who proceeded to the oral feeding in the shortest period was the pacifier group ( p < 0·05), followed by the lullaby group and the control group, respectively ( p > 0·05). We also found that the highest sucking success was achieved by infants in the pacifier group ( p < 0·05) followed by the lullaby group ( p > 0·05). Conclusion. These results demonstrate that giving pacifiers to premature infants and making them listen to lullabies has a positive effect on their transition period to oral feeding, their sucking success and vital signs (peak heart rate and oxygen saturation). Relevance to clinical practice. Neonatal intensive care nurses can accelerate premature infants' transition to oral feeding and develop their sucking success by using the methods of giving them pacifiers and making them listen to lullabies during gavage feeding. [ABSTRACT FROM AUTHOR]

Çelik S, Yıldırım İ, Arslan İ, Yıldırım S, Erdal F, Yandı YE. International Journal of Nursing Practice 2011; 17: 556-561 Hemodynamic and oxygenation changes in surgical intensive care unit patients with fever and fever lowering nursing interventions The purpose of this study was to determine the effects of fever and nursing interventions to lower fever on hemodynamic values and oxygenation in febrile (temperature greater than 38.3°C) surgical intensive care unit patients. This retrospective study was conducted in 53 febrile patients out of 519 patients admitted to the surgical intensive care unit at a university hospital. Data were obtained from the medical records, laboratory files and nursing notes. Statistical analysis of the data was analyzed by repeated measures analysis of variance and a paired sample t-test. The average hourly urine output (F = 5.46; P = 0.002) and systolic blood pressure (F = 2.87; P = 0.03) were significantly lower after fever onset. Heart rate, respiratory rate, positive end-expiratory pressure settings and FiO2 settings were unchanged after the development of fever. Diastolic blood pressure and oxygen saturation had non-statistically significant decreases. Nursing interventions for febrile patients consisted of medication administration (69.8%), ice (62.3%) and sponging with tepid water (62.3%). The present results showed that fever was associated with an increase in heart rate, decreased systolic arterial pressure, mean arterial pressure, oxygen saturation and hourly urine output. [ABSTRACT FROM AUTHOR]