NAVIGATING AIRWAY CHALLENGES IN POST-CABG CARE: A CROSS-SECTIONAL STUDY FROM TERTIARY CARE HOSPITALS OF KARACHI
Main Article Content
Keywords
Ineffective airway clearance, CABG, Clinical indicators and Nursing Diagnosis
Abstract
Background: After coronary artery bypass grafting (CABG) surgery there is restriction of chest movement due to sternal incision which results in the inability of coughing appropriately to clear up the secretion plugged into the respiratory tract. This complication can lead to ineffective airway clearance (IAC), a common nursing diagnosis observed in patients’ post-CABG. Unrecognized and untreated, IAC may progress to significant pulmonary sequestration or even death. By using NANDA-I Taxonomy II, the person who would be able to recognize clinical clues is a nurse. The role of nurses in reversing this condition cannot be overstated.
Aims: The purpose of this study was to evaluate the most common laboratory indicators in patients undergoing IAC following CABG. For early diagnosis there may be signals for the clinical devastation due to infective endocarditis.
Methodology: A total of 113 patients were enrolled after CABG surgery from Dow University Hospital (DUH), Ojha campus and Tabba Heart Institute (THI) Karachi. Cross-Sectional study design was used to conduct this study. To check the statistical accuracy of clinical indicators of IAC, statistical analysis was performed by predictive value, sensitivity, specificity. Moreover, the likelihood ratio, diagnostic odds ratio, area under the ROC curve and accuracy were calculated with statistical formula.
Results: The clinical indicators, Ineffective cough, adventitious breath sounds, and excessive sputum, showed more than 80% accuracy while identifying the IAC correctly. While calculating the sensitivity of the clinical indicators, adventitious breath sounds showed the highest value of 84%, and Ineffective cough and excessive sputum were found with 81% sensitivity, respectively. It was also found that all clinical indicators showed more than 90% positive predictivity.
Conclusion: This study showed three clinical indicators with higher sensitivity to diagnose IAC in post CABG patients that includes adventitious breath sounds, ineffective cough, and excessive sputum.
References
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25. Jones I and Johnson M. What is the role of the coronary care nurse? A review of the literature. Eur J Cardiovasc Nurs 2008; 7: 163−170.
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28. Mendes, L. C., Cavalcante, J. C. B., Lopes, M. V. O., & Lima, L. H. O. (2012). Ineffective airway clearance in children with asthma: A descriptive study. Texto e Contexto Enfermagem, 21(2), 371–378. http://dx.doi.org/10.1590/S0104-07072012000 200015 (Internet)
29. Silveira, U. A., Lima, L. H. O., & Lopes, M. V. O. (2008). Defining characteristics of the nursing diagnoses ineffective airway clearance and ineffective breathing pattern in asthmatic children. Revista da Rede de Enfermagem do Nordeste, 9(4), 125–133 Avaliable from: http://www.revistarene.ufc.br/revista/index.php/revista/article/view/629/pdf).
30. Silva, F. A., Lopes, T.M., Duarte, J., &Medeiros, R. F. (2010). Physiotherapeutic treatment in postoperative of laparotomy. The Journal of the Health Sciences Institute, 28(4), 341–344 Avaliable from: http://www.unip.br/comunicacao/publicacoes/ics/edicoes/2010/04_out-dez/V28_n4_2010_p341-344.pdf
31. Siddiqui, A. R. O., Yasmeen, N., Taranikanti, M., & Panda, S. (2014). Comparative study of preoperative and postoperative pulmonary function in open abdominal surgeries. International Journal of Biomedical Research, 5(12), 741–743. http://dx.doi.org/10.7439/ijbr.v5i12.803
32. Hinkle, J. L., & Cheever, K. H. (2013). Brunner & Suddarth's Textbook of Medical-surgicalnNursing. Philadelphia: Lippincott Williams & Wilkins.
33. Bickley, Lynn S. (2003). Bates' Guide to Physical Examination and History Taking. Philadelphia: Lippincott Williams & Wilkins.
34. John, U. Latent Class Models for the Analysis of Rater or Test Agreement.” John Uebersax Home Page, John Uebersax PhD, Jan. 2019, https://www.john-uebersax.com/stat/lcm.htm#refer.
35. Wilkins RL and Stoller JK. Egan’s fundamental of respira¬tory care. St. Louis: Mosby, 2003.
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37. Carpenito-Moyet, L. J. (2007). Understanding the nursing process: Concept mapping and care planning for students. Philadelphia: Lippincott Williams & Wilkins.
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41. Swartz MH. Textbook of physical diagnosis: history and examination. Philadelphia: Saunders, 2001.
42. Wynne R and Botti M. (2004) Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care; 13: 384−393.
43. Gaudino, M., (2024). European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery. European Journal of Cardio-Thoracic Surgery. 65, ezad415.
44. D’Agostino, D. (2019). The preoperative inflammatory status affects the clinical outcome in cardiac surgery. Antibiotics. 8, 176.
45. Jage, B., Thakur, A. (2022). Effectiveness of Acapella along with institutional based chest physiotherapy techniques on pulmonary functions and airway clearance in post-operative CABG patients. Hong Kong Physiotherapy Journal. 42, 81-89.
46. Mali, S., Haghaninejad, H. (2019). Pulmonary complications following cardiac surgery. Archives of medical sciences. Atherosclerotic diseases. 4, e280.
47. Hillman, D. R. (2021). Sleep loss in the hospitalized patient and its influence on recovery from illness and operation. Anesthesia & Analgesia. 132, 1314-1320.
48. Stephens, R. S., Whitman, G. J. (2015). Postoperative critical care of the adult cardiac surgical patient. Part I: routine postoperative care. Critical care medicine. 43, 1477-1497.
49. Pooria, A. (2020). Postoperative complications associated with coronary artery bypass graft surgery and their therapeutic interventions. Future Cardiology. 16, 481-496.
50. Tsai, T. C., et al., 2013. Variation in surgical-readmission rates and quality of hospital care. New England Journal of Medicine. 369, 1134-1142.
51. Shahu, A., et al., 2023. Liberation from mechanical ventilation in the cardiac intensive care unit. JACC: Advances. 2, 100173.
52. Da Silva, V. M. (2009). Clinical indicators of ineffective airway clearance in children with congenital heart disease. Journal of clinical nursing. 18, 729-736.
53. Shahood, H. (2022). Effectiveness of preoperative chest physiotherapy in patients undergoing elective cardiac surgery, a systematic review and meta-analysis. Medicina. 58, 911.
54. Wang, Y. (2022). Comparison of Tools for Postoperative Pulmonary Complication Following Cardiac surgery.
55. Panossian, V. S. (2024). The impact of comorbidities and functional status on outcomes in the older adult emergency general surgery patient. The American Journal of Surgery. 237, 115903.
56. Odor, P. M. (2020). Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. Bmj. 368.
57. Razzaq, A., Rasheed, A., Ahmed, S., & Shah, H. (2023). Frequency of the clinical indicators of ‘ineffective airway clearance’among patients after coronary artery bypass grafting at tertiary care hospitals Karachi, Pakistan. The Professional Medical Journal, 30(01), 23-28.
58. Lee, S., Collins, E. G. (2021). Factors influencing physical activity after cardiac surgery: an integrative review. Heart & Lung. 50, 136-145.
2. De Sousa VE, de Oliveira Lopes MV, de Araujo TL, Rolim IL, do Nascimento RV, Oliveira TF. Clinical indicators of ineffective airway clearance for patients in the cardiac postoperative period. European Journal of Cardiovascular Nursing. 2013 Apr;12(2):193-200.
3. Lalonde, G., 2016. Cardiopulmonary Bypass and Mechanical Support: Principles and Practice. Lippincott Williams & Wilkins.
4. Pascoal LM, de Carvalho JP, de Sousa VE, Santos FD, Neto PM, Nunes SF, de Oliveira Lopes MV. Ineffective airway clearance in adult patients after thoracic and upper abdominal surgery. Applied Nursing Research. 2016 Aug 1;31:24-8.
5. Sanson G, Vellone E, Kangasniemi M, Alvaro R, D'agostino F. Impact of nursing diagnoses on patient and organizational outcomes: a systematic literature review. Journal of clinical nursing. 2017 Dec;26(23-24):3764-83.
6. Herdman TH, editor. Nursing diagnoses 2015-17: definitions and classification. John Wiley & Sons; 2011 Nov 14.
7. Hulzebos EH, Van Meeteren NL, De Bie RA, Dagnelie PC, Helders PJ. Prediction of postoperative pulmonary complications on the basis of preoperative risk factors in patients who had undergone coronary artery bypass graft surgery. Physical therapy. 2003 Jan 1;83(1):8-16.
8. Moreno AM, Castro RR, Sorares PP, Sant'Anna M, Cravo SL, Nóbrega AC. Longitudinal evaluation the pulmonary function of the pre and postoperative periods in the coronary artery bypass graft surgery of patients treated with a physiotherapy protocol. Journal of cardiothoracic surgery. 2011 Dec;6(1):62.
9. Sivakumar S, Taccone FS, Desai KA, et al. ESICM LIVES 2016: part two: Milan, Italy. 1–5 October 2016. Intensive Care Med Exp. 2016;4(Suppl 1):30. Published 2016 Sep 29. doi:10.1186/s40635-016-0099-9
10. Davoudi M, Farhanchi A, Moradi A, Bakhshaei MH, Safarpour G. The effect of low tidal volume ventilation during cardiopulmonary bypass on postoperative pulmonary function. The journal of Tehran Heart Center. 2010;5(3):128.
11. Chu H, Dang BW. Risk factors of postoperative pulmonary complications following elective craniotomy for patients with tumors of the brainstem or adjacent to the brainstem. Oncol Lett. 2014 Oct;8(4):1477-1481. doi: 10.3892/ol.2014.2374. Epub 2014 Jul 23. PMID: 25202352; PMCID: PMC4156239.
12. Loeckinger A, Kleinsasser A, Lindner KH, Margreiter J, Keller C, Hoermann C. Continuous positive airway pressure at 10 cm H2O during cardiopulmonary bypass improves postoperative gas exchange. Anesthesia & Analgesia. 2000 Sep 1;91(3):522-7.
13. Sánchez-Véliz R, Carmona MJ, Otsuki DA, et al. Impact of Cardiopulmonary Bypass on Respiratory Mucociliary Function in an Experimental Porcine Model. PLoS One. 2015;10(8):e0135564. Published 2015 Aug 19. doi:10.1371/journal.pone.0135564
14. De Sousa VE, Lopes MV, da Silva VM. Systematic review and meta‐analysis of the accuracy of clinical indicators for ineffective airway clearance. Journal of advanced nursing. 2015 Mar;71(3):498-513.
15. American Nurses Association. (2015) Nursing: Scope and Standards of Practice (3rd ed.) Silver Spring, MD: ANA
16. Zeitoun SS, De Barros AL, Michel JL, De Bettencourt AR. Clinical validation of the signs and symptoms and the nature of the respiratory nursing diagnoses in patients under invasive mechanical ventilation. Journal of Clinical Nursing. 2007 Aug 1;16(8):1417-26.
17. Rocha LA, Maia TF, Silva LD. Nursing diagnoses in patients outgoing cardiac surgery. Revista brasileira de enfermagem. 2006 Jun;59(3):321-6.
18. Openepi.com. (2019). OpenEpi Menu. [online] Available at: http://www.openepi.com/Menu/OE_Menu.htm [Accessed 16 Jul. 2019].
19. Baratloo A, Elfil M, Negida A. Part 3: Positive and Negative Likelihood Ratios of Diagnostic Tests.Emergency-An Academic Emergency Medicine journal. 2015;3(4):170–1. [PMC free article] [PubMed]
20. Baratloo, A., Hosseini, M., Negida, A., & El Ashal, G. (2015). Part 1: Simple Definition and Calculation of Accuracy, Sensitivity and Specificity. Emergency (Tehran, Iran), 3(2), 48-9.
21. Šimundić AM. Measures of diagnostic accuracy: basic definitions. Ejifcc. 2009 Jan;19(4):203.
22. Inoue, J., Ono, R., Makiura, D., Kashiwa‐Motoyama, M., Miura, Y., Usami, M., Nakamura, T., Imanishi, T., & Kuroda, D. (2013). Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Diseases of the Esophagus, 26(1), 68–74. http://dx.doi.org/10.1111/j.1442-2050.2012.01336.x (Internet).
23. Evans TI, Joo NS, Keiser NW, et al. Glandular Proteome Identifies Antiprotease Cystatin C as a Critical Modulator of Airway Hydration and Clearance. Am J Respir Cell Mol Biol. 2016;54(4):469–481. doi:10.1165/rcmb.2015-0090OC
24. Tastan S, Linch GC, Keenan GM, et al. Evidence for the existing American Nurses Association-recognized standardized nursing terminologies: a systematic review. Int J Nurs Stud. 2014;51(8):1160–1170. doi:10.1016/j.ijnurstu.2013.12.004.
25. Jones I and Johnson M. What is the role of the coronary care nurse? A review of the literature. Eur J Cardiovasc Nurs 2008; 7: 163−170.
26. Lunney M. Current knowledge related to intelligence and thinking with implications for the use and development of case studies. Int J Nurs Terminol Classif 2008; 19: 158−162.
27. Canet, J., & Gallart, L. (2014). Postoperative respiratory failure: Pathogenesis, prediction, and prevention. Current Opinion in Critical Care, 20(1), 56–62. http://dx.doi.org/10. 1097/MCC.0000000000000045 (Internet).
28. Mendes, L. C., Cavalcante, J. C. B., Lopes, M. V. O., & Lima, L. H. O. (2012). Ineffective airway clearance in children with asthma: A descriptive study. Texto e Contexto Enfermagem, 21(2), 371–378. http://dx.doi.org/10.1590/S0104-07072012000 200015 (Internet)
29. Silveira, U. A., Lima, L. H. O., & Lopes, M. V. O. (2008). Defining characteristics of the nursing diagnoses ineffective airway clearance and ineffective breathing pattern in asthmatic children. Revista da Rede de Enfermagem do Nordeste, 9(4), 125–133 Avaliable from: http://www.revistarene.ufc.br/revista/index.php/revista/article/view/629/pdf).
30. Silva, F. A., Lopes, T.M., Duarte, J., &Medeiros, R. F. (2010). Physiotherapeutic treatment in postoperative of laparotomy. The Journal of the Health Sciences Institute, 28(4), 341–344 Avaliable from: http://www.unip.br/comunicacao/publicacoes/ics/edicoes/2010/04_out-dez/V28_n4_2010_p341-344.pdf
31. Siddiqui, A. R. O., Yasmeen, N., Taranikanti, M., & Panda, S. (2014). Comparative study of preoperative and postoperative pulmonary function in open abdominal surgeries. International Journal of Biomedical Research, 5(12), 741–743. http://dx.doi.org/10.7439/ijbr.v5i12.803
32. Hinkle, J. L., & Cheever, K. H. (2013). Brunner & Suddarth's Textbook of Medical-surgicalnNursing. Philadelphia: Lippincott Williams & Wilkins.
33. Bickley, Lynn S. (2003). Bates' Guide to Physical Examination and History Taking. Philadelphia: Lippincott Williams & Wilkins.
34. John, U. Latent Class Models for the Analysis of Rater or Test Agreement.” John Uebersax Home Page, John Uebersax PhD, Jan. 2019, https://www.john-uebersax.com/stat/lcm.htm#refer.
35. Wilkins RL and Stoller JK. Egan’s fundamental of respira¬tory care. St. Louis: Mosby, 2003.
36. Sasaki, N., Meyer, M. J., & Eikermann, M. (2013). Postoperative respiratory muscle dysfunction: Pathophysiology and preventive strategies. Anesthesiology, 118(4), 961–978. http://dx.doi.org/10.1097/ALN.0b013e318288834f.
37. Carpenito-Moyet, L. J. (2007). Understanding the nursing process: Concept mapping and care planning for students. Philadelphia: Lippincott Williams & Wilkins.
38. Jarvis, C., Browne, A. J., MacDonald-Jenkins, J., Luctkar-Flude, M., & Camera, I. M. (2013). Physical examination and health assessment (6th ed.). St. Louis: Elsevier Saunders. Kowalak, J. D., & Munden, J. (2008). Nurse's five-minute clinical consult: Signs and symptoms. Ambler: Lippincott Williams & Wilkins.
39. Lopes, M. V., Silva, V. M., & Araujo, T. L. (2012). Methods for establishing the accuracy of clinical indicators in predicting nursing diagnoses. International Journal of Nursing Knowledge, 23(3), 134–139. http://dx.doi.org/10.1111/j.2047-3095.2012.01213.x
40. Zhou X, Obuchowski NA and McClish DK. Statistical methods in diagnostic medicine. New York: John Wiley, 2002
41. Swartz MH. Textbook of physical diagnosis: history and examination. Philadelphia: Saunders, 2001.
42. Wynne R and Botti M. (2004) Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care; 13: 384−393.
43. Gaudino, M., (2024). European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery. European Journal of Cardio-Thoracic Surgery. 65, ezad415.
44. D’Agostino, D. (2019). The preoperative inflammatory status affects the clinical outcome in cardiac surgery. Antibiotics. 8, 176.
45. Jage, B., Thakur, A. (2022). Effectiveness of Acapella along with institutional based chest physiotherapy techniques on pulmonary functions and airway clearance in post-operative CABG patients. Hong Kong Physiotherapy Journal. 42, 81-89.
46. Mali, S., Haghaninejad, H. (2019). Pulmonary complications following cardiac surgery. Archives of medical sciences. Atherosclerotic diseases. 4, e280.
47. Hillman, D. R. (2021). Sleep loss in the hospitalized patient and its influence on recovery from illness and operation. Anesthesia & Analgesia. 132, 1314-1320.
48. Stephens, R. S., Whitman, G. J. (2015). Postoperative critical care of the adult cardiac surgical patient. Part I: routine postoperative care. Critical care medicine. 43, 1477-1497.
49. Pooria, A. (2020). Postoperative complications associated with coronary artery bypass graft surgery and their therapeutic interventions. Future Cardiology. 16, 481-496.
50. Tsai, T. C., et al., 2013. Variation in surgical-readmission rates and quality of hospital care. New England Journal of Medicine. 369, 1134-1142.
51. Shahu, A., et al., 2023. Liberation from mechanical ventilation in the cardiac intensive care unit. JACC: Advances. 2, 100173.
52. Da Silva, V. M. (2009). Clinical indicators of ineffective airway clearance in children with congenital heart disease. Journal of clinical nursing. 18, 729-736.
53. Shahood, H. (2022). Effectiveness of preoperative chest physiotherapy in patients undergoing elective cardiac surgery, a systematic review and meta-analysis. Medicina. 58, 911.
54. Wang, Y. (2022). Comparison of Tools for Postoperative Pulmonary Complication Following Cardiac surgery.
55. Panossian, V. S. (2024). The impact of comorbidities and functional status on outcomes in the older adult emergency general surgery patient. The American Journal of Surgery. 237, 115903.
56. Odor, P. M. (2020). Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. Bmj. 368.
57. Razzaq, A., Rasheed, A., Ahmed, S., & Shah, H. (2023). Frequency of the clinical indicators of ‘ineffective airway clearance’among patients after coronary artery bypass grafting at tertiary care hospitals Karachi, Pakistan. The Professional Medical Journal, 30(01), 23-28.
58. Lee, S., Collins, E. G. (2021). Factors influencing physical activity after cardiac surgery: an integrative review. Heart & Lung. 50, 136-145.
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Dec 31, 2024
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Abida Razzaq, Hakim Shah, Razia Bibi, Shabana Abbas, Fouzia Ayyaz, Abdur Rasheed, & Ishrat Naveed. (2024). NAVIGATING AIRWAY CHALLENGES IN POST-CABG CARE: A CROSS-SECTIONAL STUDY FROM TERTIARY CARE HOSPITALS OF KARACHI. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1926-1942. https://doi.org/10.53555/m8rhbs07
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Author Biographies
Abida Razzaq
Pakistan Navy Nursing College Bahria University, Karachi, Pakistan
Hakim Shah
Indus College of Nursing and Midwifery, The Indus Hospital, Karachi, Pakistan
Razia Bibi
Shiekh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan
Shabana Abbas
Shiekh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan
Fouzia Ayyaz
Shiekh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan
Abdur Rasheed
School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
Ishrat Naveed
Shiekh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan
How to Cite
Abida Razzaq, Hakim Shah, Razia Bibi, Shabana Abbas, Fouzia Ayyaz, Abdur Rasheed, & Ishrat Naveed. (2024). NAVIGATING AIRWAY CHALLENGES IN POST-CABG CARE: A CROSS-SECTIONAL STUDY FROM TERTIARY CARE HOSPITALS OF KARACHI. Journal of Population Therapeutics and Clinical Pharmacology, 31(11), 1926-1942. https://doi.org/10.53555/m8rhbs07