Dyspnea, Mobility Limitation, Pain, Respiratory Insufficiency
Conditions
Keywords
I COUGH, Dyspnea, Respiratory Parameters, Pain, Major Abdominal Surgery
Brief summary
The purpose of the current study was to investigate the effect of the I COUGH care program following major abdominal surgery dyspnea, oxygen saturation, pulmonary function, mobility, and pain after major abdominal surgery (MAS), participants were subjected to the I COUGH care program designed to support their health condition and reduce complications. The study aimed to investigate a simple and inexpensive pulmonary care program that can be easily understood and remembered by patients, their families, and medical staff. Ho: The I COUGH care program after MAS does not improves pulmonary functions, oxygen saturation, mobility and decrease dyspnea and pain after MAS. H1: The I COUGH care program improves pulmonary functions, oxygen saturation mobility and decrease dyspnea and pain after MAS.
Detailed description
A total of 60 adult individuals aged between 30 and 60 years (mean age of 39.9±8.82) comprising 13 males and 47 females underwent major abdominal surgery requiring general anesthesia and hospitalization were invited to study. Patients were randomly assigned to either the Control Group (CG, n=30) or the Experimental Group (EG, n=30) using the block randomization method. Patients in the EG participated in the I COUGH care program included flow-incentive spirometer, oral care, coughing and breathing exercises, patient, and family education, getting out of bed, and elevating the head of the bed by more than 30 degrees for 3 days post-surgery. The patients in the CG did not undergo any interventions. All participants were assessed in terms of vital signs as heart rate, blood pressure, respiratory rate, and oxygen saturation. Moreover, dyspnea was assessed using the Modified Borg dyspnea Scale, pulmonary functions were evaluated using spirometry, mobility was assessed by Activity and Mobility Promotion scale and pain assessed Visual Analog Scale. Data were collected from all patients at baseline 10 h after the first day of surgery and on the day of discharge from the hospitals. The findings of the present study revealed that the I COUGH care program effectively improved pulmonary function and blood oxygenation, reduced the incidence of dyspnea, increased mobility, and decreased postoperative pain, with a statistically significant difference between the experimental and control groups (p\<0.05).
Interventions
OTHERI COUGH care program
The I COUGH program, initiated 10 hours after surgery, emphasizes the following elements: Incentive spirometry: Encouraging patients to use the Flow-IS device ten times every two hours for three days. Coughing and deep breathing: Participants should perform 3-5 coughs and deep breaths every 2 hours for 3 days. Oral care: Brushing teeth and using mouthwash twice daily between 8:00 a.m. and 8:00 p.m. Mouth brushes should be sterile, and non-alcoholic mouthwash is recommended. Understanding (education): Patients and their relatives receive instructions on the care program and steps to follow. Getting out of bed: Patients are encouraged to sit in a chair at least once and walk at least 3 times per day in the room and corridor with assistance as needed. Head-of-bed elevation: Keeping the head of the bed elevated more than 30 degrees.
Sponsors
Yeditepe University
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Masking description
Participants in the control group were not given any information or training before or after the operation, and they were on routine hospital care.
Intervention model description
The sample of the study (n=60) consisted of patients underwent major abdominal surgery required general anesthesia and hospital stay who got diagnosed by consultant general and bariatric surgery, being between 30-60 years old (39.9±8.82 years old; 47 F/ 13 M) volunteered to attend this study. The participants were randomly divided into two groups.
Eligibility
Sex/Gender
ALL
Age
30 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* Volunteering to participate in the study. * Eligible patients are adults of both sexes between 30-60 years (Through the study, we are trying to reduce the variance and confounding factors that may arise from including patients who are less than 30 years old due to different stages of growth, physical abilities, hormonal levels, etc., or over 60 years old due to the prevalence of chronic diseases or diseases associated with aging). * Patients underwent elective abdominal surgery that required general anaesthesia and hospital stay e.g., Hernia repair, gall bladder removal, exploratory laparotomy, morbid obesity, ovarian cyst, Sigmoid diverticulitis, appendicitis, or other abdominal cavity procedures performed by laparoscopy and conventional laparotomy with a 5 cm or less incision above or extending above the umbilicus. (Incisions \> 5cm may affect on possible results might be impacted in terms of: Increased risk of infection, risk of bleeding, pain, and discomfort during ambulation).
Exclusion criteria
* The patient complains of an unstable heart rate or cardiac condition. * Symptomatic heart failure, unstable angina. * Pulmonary Hypertension * Unstable hypertension * The patient underwent organ transplants. * The patient presented an aneurysm of any arterial segment. * Serious condition or transferred to the intensive care unit after surgery. * Severe nephropathy. * A patient with cancer. * Cerebrovascular accident / Stroke. * Patient with balance or vestibular disorder.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Heart Rate (HR) | 3 days of postoperatively | The number of heart beats per minute. |
| Systolic Blood pressure (SBP) | 3 days of postoperatively | The minimum pressure recorded just prior to the next contraction. |
| Diastolic Blood pressure (DBP) | 3 days of postoperatively | The maximum blood pressure during contraction of the ventricles. |
| Respiratory Rate (RR) | 3 days of postoperatively | The number of breaths they take per minute. |
| Oxygen Saturation (SPO2) | 3 days of postoperatively | A pulse oximeter reading that indicates what percentage of your blood is saturated. |
| Modified Borg Dyspnea Scale (MBDS) | 3 days of postoperatively | A valid and reliable tool to measure the intensity of dyspnea. It is a categorical scale with ratio properties, rating from 0 to 10, 0 being not dyspneic at all and 10 being maximally dyspneic. |
| Pulmonary Function Test FVC | 3 days of postoperatively | Noninvasive test that show how well the lungs are working, measuring of FVC |
| Pulmonary Function Test FEV | 3 days of postoperatively | Noninvasive tests that show how well the lungs are working, measuring of FEV |
| Pulmonary Function Test FEV1/FVC | 3 days of postoperatively | Noninvasive tests that show how well the lungs are working, measuring of FEV1/FVC |
| Pulmonary Function Test PEFR | 3 days of postoperatively | Noninvasive tests that show how well the lungs are working, measuring of PEFR. |
| Activity and Mobility Promotion (AMP) | 3 days of postoperatively | AMP is based on measuring increasing patient mobility during hospital stay. The initial goals of this program included mobilization of each patient 3 times per day, documentation of patient mobility levels on the AMP scale. |
| Visual Analogue Scale (VAS) | 3 days of postoperatively | This measure is based on self-reported symptoms and is recorded with a single mark placed along a 10-cm line, which represents a continuum between no pain on the left end (0 cm) and worst pain on the right end. to determine the intensity of pain and its enhancement when coughing in the postoperative area. |
Countries
Libya
Outcome results
None listed