Comparison of Central Venous Pressure (Cvp) Score Among Patients on Mechanical Ventilator With Head of Bed (Hob) Elevation 30O; Neutral, Right, and Left Side Positions

Abstract

Comparison of Central Venous Pressure (Cvp) Score Among Patients on Mechanical Ventilator With Head of Bed (Hob) Elevation 30O; Neutral, Right, and Left Side Positions Setiyawan1 , Kusman Ibrahim2 , Titin Mulyati3 1 STIKes Kusuma Husada Surakarta, Surakarta, Indonesia 2 Faculty of Nursing Universitas Padjadjaran, Bandung, Indonesia 3 General Intensive Care Unit RSUP dr. Hasan Sadikin, Bandung, Indonesia Corresponding Email: etya1025@gmail.com Submitted: 11-04-2018 Accepted: 08-02-2019 Published: 11-04-2019 Abstract Early mobilization is important for critical patients to improve cough reflex, relieve bronchial secretions, facilitate the work of mucociliary drainage muscles, and to prevent ventilator-associated pneumonia and pressure sores. However, at the same time patients often experience changes in vital signs due to fluctuating conditions. Central Venous Pressure (CVP) measurement is often necessary to monitor the central circulatory system. Unfortunately, in a clinical setting, the patient’s position must be changed first to a 30o neutral head of bed (HoB) position rather than the left or right side HoB position. This study aims to determine differences in CVP scores among patients in mechanical ventilation at 30o HoB position elevation in a neutral, right, and left. This quantitative comparative study involved 24 subjects who were recruited sequentially. Data were analyzed using ANOVA. The results showed that the mean CVP value at the elevation of the neutral HoB position elevation was 13.5 ± 3.96, the HoB elevation on the right side was 12.8 ± 4.16, and the HoB elevation on the left side was 14.4 ± 4.17. There is a significant difference (p <0.05) among the three positions. The post hoc analysis test found that the HoB 30o neutral position vs the left side position was higher and significantly different from the HoB 30o elevation in the neutral vs right side position (p <0.05). This study suggests that nurses need to consider changes in CVP values while changing the position of the patients with a HoB elevation of 30o in a neutral position, right side, and left side. Although statistically there is a difference among the three positions, in fact the difference in value is less than 1 cmH2O which is not clinically evident. Keywords: Central venous pressure, HoB elevation, Mechanical ventilation