Effects of a bedbath on mixed venous oxygen saturation and heart rate in coronary artery bypass graft patients

Abstract

OBJECTIVE: To determine the physiologic effects of a bedbath on critically ill patients. METHODS: Thirty hemodynamically stable coronary artery bypass graft patients were studied less than 24 hours after surgery in a repeated measures, quasi-experimental design. Study sites were the medical/surgical and coronary intensive care units of a large community hospital in the south-central United States. Two bedbaths consisting of bathing and turning phases were given to subjects early (mean, 3.6 hours) and late (mean, 18.5 hours) in the immediate postoperative period. Mixed venous oxygen saturation (Svo2) and heart rate were recorded at 1-minute intervals before, during, and for 5 minutes after each bedbath. RESULTS: Mean Svo2 decreased from baseline during the bathing phase of early and late bedbaths 1.6% and 1.9%, respectively, whereas mean heart rate increased from baseline 3.2% and 1%, respectively. During the turning phase, mean Svo2 decreased from baseline 9.2% and 12.1%, respectively, whereas mean heart rate increased from baseline 5.2% and 1.8%, respectively. Svo2 declined to less than 53% in 10 (33%) subjects during both early and late bedbaths. The most severe decreases in Svo2 occurred during early bedbaths and were usually associated with coughing, shivering, and/or agitation. CONCLUSIONS: Early bedbaths caused more dramatic declines in Svo2 than late bedbaths. Coughing, shivering, and agitation accentuated Svo2 declines and could be prevented by waiting to bathe coronary artery bypass graft patients until 1 day postoperatively. Routine bathing, at least in the early postoperative period, should be reconsidered.

Padrão oxihemodinâmico não-invasivo durante o banho no leito de pacientes com infarto agudo do miocárdio: Ensaio clínico

“…Uma outra variável de destaque, o VS em repouso mostrou-se normal, com diferença estatisticamente significante quando comparado com a lateralização para a esquerda (p=0,005), de forma semelhante à descrita na literatura (Atkins et al, 1994). Tendo em vista que não houve repercussões clínicas, infere-se que um possível fator de influência seja a movimentação (DLE-DLD).…”

“…No que tange à distensibilidade/rigidez do sistema vascular arterial, representada pela variável TAC, identificou-se oscilação após o posicionamento em DLE, de forma semelhante às alterações ocorridas nas variáveis de fluxo sanguíneo (IC) e contratilidade (LVET e LCW). O período de permanência em decúbito lateral é associado ao maior consumo oximétrico, cujo efeito deletério do DLE pode ser atribuído à compressão e redução da pressão diastólica final do ventrículo esquerdo (Atkins et al, 1994).…”

“…Outrossim, a duração do banho também deve ser considerada um fator de importância, uma vez que estudos evidenciaram que pacientes após 24 horas de cirurgia cardíaca apresentaram melhor resposta sobre a variação de saturação venosa de oxigênio (SvO2) com tempo de banho inferior a 20 minutos (Atkins et al, 1994;Lima & Lacerda, 2010).…”

Repercussões oxi-hemodinâmicas da lateralização de pacientes até 72 h após síndrome coronariana aguda: ensaio clínico

“…Quanto ao VS, FC e IC observa-se que as principais mudanças ocorrem em DLE, assim como descrito na literatura (Atkins et al, 1994;Vollman, 2010). Na amostra analisada a FC aumentou e VS que diminuiu em relação ao DD inicial, ambas também sem significância estatística (p=0,17).…”

Daily nursing care on patients undergoing venous–venous extracorporeal membrane oxygenation: a challenging procedure!

“…Few data are available on daily nursing care in ICU; recently, Coyer et al described an Australian ICU bed bath practice consisting of a sponge bath with soap and water, sheet replacement and position change. Other reports showed a temporarily increase in ''work of breathing'' and oxygen consumption during daily nursing care activities (bed baths and turning-repositioning) in critically ill patients [2][3][4][5][6][7][8][9][10][11]. More recently, Happ et al raised several concerns about performing bed bath in patients undergoing weaning trial, underlining the importance of collaboration between nurses and clinicians to define which patients could tolerate nursing care and when to perform it [12].…”