[Level of sedation level and modifications of vital signs during hygienic care in patients admitted to an intensive care unit].

INTRODUCTION

Hygienic care practices may represent a source of stress for intensive care patients.

AIM

To identify the hygienic care practices more involved in changes of vital signs and the association to the level of sedation.

METHODS

Prospective observational study of eleven patients admitted to a general intensive care unit, observed for three consecutive hygiene care morning practices. A protocol for standardizing hygiene practices was adopted. Vital signs were recorded on an electronic database at the beginning of each of the following phase: before the start of hygiene, of mouth cleaning, of sponge bath, positioning of bedpan, first and second side rotation, change of position of endotracheal tube and replacement of tapes, and at the end of hygiene.

RESULTS

29 events of hygiene practices were observed in the 11 patients included in the study (the measurements of three events were discarded). Significant vital signs alterations were induced mainly by the rotation and change of position of the orotracheal tube. Significant correlations were observed between changes in Heart Rate and Bispectral Index (BIS) (coefficient of 0.345; P: 0.329), between BIS and systolic arterial blood pressure (0.774, P: 0.009), BIS and Tidal Volume (-0.569, P: 0.086), and BIS and Respiratory Rate (0.707, P: 0.022).

CONCLUSIONS

The hygienic care in intensive care patients may negatively impact on vital signs. Some nursing manoeuvres cause variations of the vital signs also related to changes in the state of consciousness caused by possible defects or excesses of sedation. The sedation level, during hygienic care, should be constantly monitored.