Impact of nursing care on lung functional residual capacity in acute respiratory distress syndrome patients.

Abstract

BACKGROUND\nThe respiratory consequences of daily nursing care interventions in patients with acute respiratory distress syndrome (ARDS) are not clearly established.\n\n\nAIMS AND OBJECTIVES\nThe main objective of this study was to assess the feasibility of alveolar collapse analysis by the measurement of lung impedance distribution technique during nursing care in patients with ARDS.\n\n\nDESIGN\nProspective observational pilot physiologic study in a surgical intensive care unit of a tertiary care hospital including adult intubated patients with moderate-to-severe ARDS.\n\n\nMETHODS\nEach patient was monitored for 12\u2009hours using a chest impedance device. Daily care interventions studied were as follows: endotracheal suctioning, mouth care, bed-bathing, and blood sampling. The primary endpoint was the variation in end-expiratory lung impedance (reflecting functional residual capacity) before and 1, 5, 15, and 30\u2009minutes after nursing care interventions. Data are presented as median (interquartile-range).\n\n\nRESULTS\nOne hundred and eight events were collected in 18 patients. Endotracheal suctioning (n = 42), mouth care (n = 26), and bed-bathing (n = 23) induced a significant decrease in lung impedance after care: endotracheal suctioning (-40.0 [-53.8; -28.6]% at 1 minute [P\u2009<\u2009.001], -10.4 [-27.9; 1.8]% at 30\u2009minutes [P = .03]; mouth care -17.9 [-45.4; -14.6]% at 1 minute [P\u2009<\u2009.001], -10.4 [-21.3; 3.4]% at 30\u2009minutes [P = .01]; bed-bathing -40.2 [-53.5; -14.3]% at 1 minute [P\u2009<\u2009.001], -10.6 [-36.4; 1.6]% at 30\u2009minutes [P = .01]). Blood sampling (n = 17) did not induce significant changes in lung impedance.\n\n\nCONCLUSIONS\nThe lung impedance distribution technique during nursing care appears feasible in the majority of patients with ARDS. Some daily nursing care in ARDS patients (including bed-bathing and mouth care) resulted in a prolonged decrease in lung functional residual capacity and therefore could be associated with pulmonary de-recruitment.\n\n\nRELEVANCE TO CLINICAL PRACTICE\nA caregiver who has to assess the functional residual capacity of these patients should probably be informed of the schedules of the nursing care interventions.