End-Tidal Carbon Dioxide as a Measure of Stress Response to Clustered Nursing Interventions in Neurologic Patients

Abstract

Background Guidelines recommend rest periods between nursing interventions for patients with a neurologic diagnosis but do not specify a safe number of interventions. Objectives To examine the physiological stress response to clustered nursing interventions in neurologic patients receiving mechanical ventilation. Methods Prospective, comparative, descriptive design to examine effects of clustered interventions (≥6 interventions in a single nursing interaction) versus nonclustered interventions on patients’ stress. Stress response was defined as a 10% change in end-tidal carbon dioxide from before the interaction to (1) 5 and 10 minutes after the start of the interaction, (2) at the end of the interaction, and (3) 15 minutes after the interaction. Results The mean percent change in end-tidal carbon dioxide at 5 minutes differed significantly between patients with clustered interventions and patients with nonclustered interventions (6.7% vs −0.2%; P = .001). Patients with clustered interventions were significantly more likely than patients with low clustering to exhibit a stress response at 5 minutes (24.3% vs 0%; P = .01). Conclusions Neurologic patients receiving mechanical ventilation who experienced 6 or more clustered nursing interventions showed a higher mean change in end-tidal carbon dioxide than did patients who received fewer than 6 clustered interventions. These findings suggest that providing fewer interventions during 1 nursing interaction may minimize induced stress in neurologic patients receiving mechanical ventilation.

Insights and Advances in Multidisciplinary Critical Care: A Review of Recent Research

“…They gathered a small sample of nurses and identified reliability in their monitoring; however, no impact on patients' outcomes was shown. Genzler et al, 7 on the other hand, evaluated the stress reaction of patients receiving mechanical ventilation to clustered nursing interventions, showing that more than 6 interventions would trigger variations in end-tidal carbon dioxide, corresponding to an increased stress response.…”

Physiological Responses Related to Clustered Nursing Interventions among Mechanically Ventilated Patients

“…This finding is in accordance with Genzler et el. (2013) (23) who indicated that there was significant statistical difference between clustered nursing care performance and patient's respiratory rate across before, during and after clustered nursing care performance.…”

“… Administration of medication. This tool was developed by the researcher after reviewing the relevant Literature (19)(20)(21)(22)(23)(24)…”

Transendothelial Transport and Its Role in Therapeutics

“…Further, concentration of these gases in the brain comes into equilibrium with the plasma which is primarily limited by the cerebral blood flow rate. In addition, gaseous exchange brain also depends on pure ventilation and neurological, physiological, and pathological state [ 73 ]. Moreover, end tidal carbon dioxide acts as a marker of stress response in patients [ 73 ], while inert gases, like N 2 O and Xe, can be used as markers to measure cerebral blood flow.…”

“…In addition, gaseous exchange brain also depends on pure ventilation and neurological, physiological, and pathological state [ 73 ]. Moreover, end tidal carbon dioxide acts as a marker of stress response in patients [ 73 ], while inert gases, like N 2 O and Xe, can be used as markers to measure cerebral blood flow. An interesting contrast is observed between CO 2 and H + with regard to their effects on brain pH.…”