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    The effects of different degrees of head-of-bed elevation on the respiratory pattern and drainage following thyroidectomy: a randomized controlled trial
    (Makerere Univ, Fac Med, 2020) Yuksel, Serpil; Oztekin, Seher Deniz; Temiz, Zeynep; Ugras, Gulay Altun; Sengul, Emel; Teksoz, Serkan; Sunal, Nihal
    Background: The patient's position is important for ensuring patient comfort and preventing complications after thyroidectomy. Objectives: This study was carried out to determine the effects of different degrees of head-of-bed elevation (HOBE) on the respiratory pattern and drainage following thyroidectomy and to provide suggestions for evidence-based clinical practice. Methods: The sample of this prospective, parallel arm, randomized controlled trial included 114 patients undergoing thyroidectomy in a university hospital in Turkey. The patients were randomly assigned (1:1:1) to supine 0 degrees (baseline), 30 degrees and 45 degrees HOBE groups. Respiratory pattern including respiratory rate (RR), peripheral oxygen saturation (SpO(2)) and dyspnea, and drainage including amount of drainage and hematoma formation were evaluated at the 1st, 2nd, 3rd and 4th hours following thyroidectomy. Results: The majority of the patients (83.3%) were female and 84.2% had undergone total thyroidectomy. The mean RR (18.47, 95% CI=17.85-19.09) of the patients in the supine 30 degrees HOBE group at the 1st hour was significantly higher than that of the patients in the supine 0 degrees group (17.32, 95% CI=16.88-17.76; p<0.05). There was no significant difference between the SpO 2 values of the patients in the groups (p>0.05). The amount of drainage was significantly higher in the supine 0 degrees group at the 2nd hour than that of the patients in the supine 45 degrees HOBE group (5.92 +/- 5.18; 3.34 +/- 5.56 respectively; p <0.05). None of the patients in the groups had hematoma formation. While no patient in the supine 30 degrees HOBE group had dyspnea, dyspnea occurred in 9 patients in the supine 0 degrees group and in 3 patients in the supine 45 degrees HOBE group. Conclusion: This study showed that different HOBE positions resulted in clinically insignificant changes on the RR and amount of drainage during the first 4 hours following thyroidectomy but did not affect SpO(2) value.
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    Effects of Different Head-of-Bed Elevations and Body Positions on Intracranial Pressure and Cerebral Perfusion Pressure in Neurosurgical Patients
    (Lippincott Williams & Wilkins, 2018) Ugras, Gulay Altun; Yuksel, Serpil; Temiz, Zeynep; Eroglu, Selin; Sirin, Keziban; Turan, Yuksel
    Purpose: The aim of this study was to evaluate the effects of different head of bed (HOB) elevations and body positions on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to identify safe positions for neurosurgical patients with different Glasgow Coma Scale (GCS) scores. Methods: This study with a quasi-experimental, prospective repeated measures is designed with control over the intervention consisted of 30 patients hospitalized in the neurocritical care units (NCU). Patients' HOB was elevated (degree of 15,30,45) and the patients were at supine, left lateral and right lateral positions. ICP and CPP were recorded for each patient. Results: It was found that ICP increased and CPP decreased at supine, left and right lateral positions with different HOB elevations, which, however, did not reach statistical significance. When patients with a GCS score of 3-8 were at degree of 15 right and left lateral positions and 45 right lateral position; and when patients with a GCS score of 13-15 were positioned at degree of 15 left lateral, ICP and CPP changed significantly. Conclusion: The results of this study showed that different positions the patients' HOB (degree of 15,30,45) led to slight insignificant changes in ICP and CPP; and these values were maintained within the ranges established by recent guidelines.