الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 107 |  |  |
| | | from | 107 | | |
Abstract
Monitoring oxygen saturation in shocked patients is a challenging nursing procedure. Shock syndrome alters peripheral tissue perfusion and hinders peripheral capillary oxygen saturation (SpO2) measurements. Consequently, arterial oxygen saturation (SaO2) is used as an alternative to getting more accurate measurements.
The frequent arterial blood sampling can predispose patients to pain and serious complications as well as cannot provide immediate and continuous measurement. So, selecting a pulse oximeter site that can be adequately perfused to improve SpO2 measurements will save the patient from these complications and provide continuous non-invasive monitoring techniques. The pharynx is expected to be an accurate SpO2 measurement site in shocked patients.
The present study aimed to:
Compare between oxygen saturation measurements from pharyngeal versus arterial sites in shocked patients.
Materials and methods:
Research Design:
A descriptive-comparative research design was adopted in this study.
Setting:
This study was carried out in general ICUs namely; (unit I, unit II, unit III, and triage unit) at the Alexandria Main University Hospital (AMUH).
Subjects:
A convenience sample of 60 shocked adult patients of both sexes whoseBlood pressure (BP) systolic BP <90 mm Hg or a 30mm Hg fall in baseline BP or hypotension requiring the use of vasopressors to maintain mean (BP) of 65mm Hg or greater was included in this study. Patients who have recent maxillofacial surgery and severe mid-facial Trauma were excluded from this study.
Tool of the study:
To accomplish the aim of the current study, one tool was used for data collection “Oxygen Saturation Assessment’’. This tool was developed by the researcher after reviewing the related literature. It consists of three parts:
Part I:Patients’ demographic and clinical profile: This part will include patients’ age, sex, date of admission, diagnosis, past medical, surgical history, date of starting mechanical ventilator, level of consciousness, and severity of illness. Part II: Oxygen saturation measurements: This part will include measurements of pharyngeal SPO2 and SaO2 from ABG analysis from radial or femoral artery. Part III: Oxygen saturation variance factors: This part will includethe variances that will affect the oxygen saturation reading. It will include patients’ hemodynamic parameters such as heart rate, mean arterial pressure and body temperature, laboratory investigations such as ABG and hemoglobin, medications such as inotropes and vasopressors, fluid balance, intubation and mechanical ventilator parameters such as positive end-expiratory pressure (PEEP) level and mode, pharyngeal assessment such as condition and color.
Method of the study:
Official approval to conduct this study was obtained after explaining the aim of the study. The developed tool was tested for content validity by five experts in the field of the study for content validity, correction, and clarifying of needed items was done. Informed consent was obtained from each conscious patient and written consent from the guardian if unconscious after explaining the aim of the study. Voluntary participation and the right to withdraw from the study were emphasized to conscious patients or guardians in the case of unconscious patients. A pilot study was conducted before the actual study and was done on 6 patients to test the clarity and applicability of the tool, and all necessary modifications were done. The reliability of the tool was tested using Cronbach’s Alpha reliability, the reliability coefficients were (α= 0.77) which is accepted.
Data collection:
All shocked admitted patients’ to the previously mentioned units and meet the inclusion criteria were enrolled in the study.Patient’s characteristics were assessed on admission to the previously mentioned ICUs and recorded using part I of the tool.Factors that may affect the oxygen saturation reading were assessed, monitored, and recorded using part III of the tool.
A pharyngeal pulse oximeter was prepared and inserted adjacent to the tracheal tube as a substitute for a bite block.Then pharyngeal SpO2measurements were taken and recorded in part II of the tool. The measurements were taken before the optical components of the pulse oximeter that was not covered by pharyngeal secretions so if the waveform deteriorated oropharyngeal suctioning will perform. The measurements were taken within 3 hours; two values were measured from the insertion of the OPA. The SaO2 values were taken from ABG analysis from the radial or femoral artery and they were recorded in part II of the tool.
Statistical analysis:
After data collection, they were fed to the computer and analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp).Qualitative data were described using numbers and percentages. Quantitative data were described mean, standard deviation.
The main results of the study:
More than half of the patients (68.3%) in this study were males and 65% of patients were more than or equal 55 years old. Furthermore, most of the patients were admitted to unit II ICU (31.7 %). Distributive septic shock is the most common type of current diagnosis (66.7%). The medical category is the most common cause (73.3%) of ICU admission followed by trauma (20%). Concerning past medical history, more than a quarter of the patients (26.47%) had cardiovascular. The APACHE II score for studied patients was between 14 and 25 with a mean score of 19.15 ± 1.96.
The findings of the current study revealed that there was no significant difference between mean SaO2 and pharyngeal SpO2 (t =0.352, P = 0.658). It was also found that there was a very highly significant difference between mean SaO2 and mean finger SpO2 (t=33.31, P= 0.000).
It was found that there was no statistically significant difference between arterial classifications of oxygen saturation and pharyngeal classification of oxygen saturation (F=0.341, p= 0.713). It was also found that there was no statistically significant difference between arterial classifications of oxygen saturation and finger classification of oxygen saturation (F=105.78, p= 0.000).
Findings of the current study revealed that there is a statistically significant (0.00) strong positive correlation (0.97) between SaO2 and pharyngeal SpO2 measurements. It was also found that there is no statistical correlation between SaO2 and finger SpO2 measurements. r=0.13 (P=0.34).
It was found that body temperature, heart rate, blood pressure, and pulse pressure were variance factors that significantly associated with the accuracy of classifying oxygen saturation measures inSaO2 and finger SpO2 reading. On the other hand, the accuracy of classifying oxygen saturation measures in pharyngeal SpO2 reading was not significantly affected by body temperature, heart rate, and central venous pressure.
Regarding circulatory variance factors, results of the current study revealed that capillary refill, skin temperature, skin color, and peripheral pulse strength were variance factors that significantly associated with the accuracy of classifying oxygen saturation measures in SaO2 and finger SpO2 reading.WhileAllen’s test was not a variance factor that significantly associated with the accuracy of classifying oxygen saturation measures in SaO2and finger SpO2 reading.
The current study revealed that the accuracy of classifying oxygen saturation measures in pharyngeal SpO2 oxygen saturation reading was not significantlyaffected by the pharyngeal condition, pharyngeal color, oropharyngealsuctioning, and tooth condition.
Conclusion
The present study was conducted to compare between oxygen saturation measurements from pharyngeal versus arterial sites in shocked patients. Based on the results of the current study, it can be concluded that:
Pharyngeal oxygen saturations SpO2 can provide the clinical estimation to the arterial oxygen saturation SaO2 and finger oxygen saturation SpO2 in the lower level of oxygen saturation,unlike the finger oxygen saturation SpO2 which didn’t provide a clinical estimation to the arterial oxygen saturation SaO2 in the lower level of oxygen saturation. Several factors affect the finger oxygen saturations SpO2 and not affected the Pharyngeal oxygen saturations SpO2.
Recommendations
• Continuing education and training programs should be conducted to critical care nurses regarding benefits, limitations, and guidelines of using pharyngeal pulse oximetry.
• Critical care nurses should be trained on the use of pharyngeal SpO2.
• Hospital administration should provide an adequate number of pharyngeal pulse oximeters in critical care settings.
• Hospital administration should establish formally constructed written guidelines for pharyngeal SpO2 as well as for using pulse oximetry in the intensive care units must be applied.
• Variables affecting pharyngeal oxygen saturation readings should be assessed before obtaining the readings.
• Further researches are needed to confirm the current study in patients with different body system alterations.