Effect of Body Position on Oxygenation and Hemodynamic Status among Patients with Traumatic Brain Injury

Abstract

Context: Positioning is one of the most frequently performed nursing activities in the critical care unit. It is often providing a central pivotal focus for planning other nursing activities. Therapeutic positioning of the patient's head and different degrees of the head of the bed elevation has been suggested as a low-cost and simple approach to preventing secondary brain injury.
Aim: determine the effect of body position on oxygenation and hemodynamic status among patients with traumatic brain injury. Methods: Quasi-experiments (single group pre/posttest design). The study was conducted in the Critical Care Units in El-Mansoura general hospital in El-Mansoura city. A purposive sample of (67) adult patients diagnosed with traumatic brain injuries was recruited for this study. A structured socio-demographic interview questionnaire, patients’ medical records to elicit clinical variables and record cardiorespiratory assessment findings, Glasgow Coma Scale, and Richmond Agitation Sedation Scale were used to either include or exclude the patient according to the study criteria.

Results: There was a significant increase in oxygen saturation in post right lateral position from (94.93 ± 1.25 to 95.37 ± 1.17) and the semi fowler position from (95.37 ± 1.17 to 97.31 ± 11.13) compared to pre-positioning. The hemodynamic parameters (heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure) were significantly decreased in the post-semi- fowler position and then right lateral position compared to pre. Besides, the CVP is significantly increased in the semi-fowler position. Conclusion: Oxygen saturation and all hemodynamic parameters were significantly improved compared to their normal range in post- semi-fowler position, then right lateral position. Developing a nursing practice protocol for critical care nurses to position patients at the semi- fowler position after traumatic brain injury can improve oxygenation and hemodynamic parameters. Moreover, further studies should be carried out to assess the effect of other body positions in other medical conditions.