Atkins P J, Hapshe E, Riegel B
Surgical Intensive Care Unit, Sharp Memorial Hospital, San Diego, CA 92123.
Am J Crit Care. 1994 Mar;3(2):107-15.
To determine the physiologic effects of a bedbath on critically ill patients.
Thirty hemodynamically stable coronary artery bypass graft patients were studied less than 24 hours after surgery in a repeated measures, quasi-experimental design. Study sites were the medical/surgical and coronary intensive care units of a large community hospital in the south-central United States. Two bedbaths consisting of bathing and turning phases were given to subjects early (mean, 3.6 hours) and late (mean, 18.5 hours) in the immediate postoperative period. Mixed venous oxygen saturation (Svo2) and heart rate were recorded at 1-minute intervals before, during, and for 5 minutes after each bedbath.
Mean Svo2 decreased from baseline during the bathing phase of early and late bedbaths 1.6% and 1.9%, respectively, whereas mean heart rate increased from baseline 3.2% and 1%, respectively. During the turning phase, mean Svo2 decreased from baseline 9.2% and 12.1%, respectively, whereas mean heart rate increased from baseline 5.2% and 1.8%, respectively. Svo2 declined to less than 53% in 10 (33%) subjects during both early and late bedbaths. The most severe decreases in Svo2 occurred during early bedbaths and were usually associated with coughing, shivering, and/or agitation.
Early bedbaths caused more dramatic declines in Svo2 than late bedbaths. Coughing, shivering, and agitation accentuated Svo2 declines and could be prevented by waiting to bathe coronary artery bypass graft patients until 1 day postoperatively. Routine bathing, at least in the early postoperative period, should be reconsidered.
