Copyright (c) 2020 Saudurma Sirait
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Comparison the Effectiveness of the Head of Bed to 45 and 30 Degrees with Hyperoxigenation Against Oxygen Saturation During the Open Suction in Patients That Installed Mechanical Ventilation in ICU Room
Corresponding Author(s) : Saudurma Sirait
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 8 No. 2 (2020): 2020 Volume 8- Issue -2
Abstract
Background
Complications of suction are hypoxemia or hypoxia that occurs during the suction process. HOB 45 degrees with hyperoxygenation can reduce diaphragm pressure, increase alveolar expansion and increase lung volume thereby reducing oxygen desaturation during open suction.
Objective
Proving HOB 45 degrees with hyperoxygenation is more effective than HOB 30 degrees for oxygen saturation during the suction process in patients who are fitted with mechanical ventilation.
Method
True experiments with randomized control group design pre-post test design. The sample consisted of 32 people who were divided into intervention and control groups with simple random sampling technique. Interventions of HOB 45 and 30 degrees with hyperoxygenation of oxygen saturation during open suction. Data analysis uses repeated measure ANOVA and Independent t test.
Results
HOB 45 degrees for 30 minutes with hyperoxygenation for 2 minutes is more effective in reducing oxygen desaturation during the suction process which is characterized by an average oxygen saturation value immediately after suction of 98.63% in the intervention group while HOB 30 degrees for 30 minutes with hyperoxygenation for 2 minutes, the value the average oxygen saturation immediately after suction was 95.75% in the control group.
Conclusion
HOB 45 degrees with hyperoxygenation effectively increases oxygen saturation after open suction
Keywords
HOB
Semi-fowler
Hyperoxygenation
Open suction
Oxygen saturation
References
-
[1]. Patricia M.G, Dorrie F, Carolyn H M, and Barbara G M, Critical Care Nursing: A Holistic Approach. Jakarta: EGC, 2018.
[2]. Price SA, Wilson L.M Guideline, "Endotracheal Suctioning Of Mechanically Ventilated Patients With Artificial Arway," Respitaory Care., 55, 2010, 758-64.
[3]. Opdahl H. (Acute Respiratory Failure Concomitant with Serious Disease or Injury). Tidsskrift for Den Norske Laegeforening: tidsskrift for practice medicin, ny raekke," 2010, 154- 7.
[4]. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, and Esteban A et al, "Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries," Jama, 2016, 788-800.
[5]. Rezoagli E, Fumagalli R, Bellani G, "Definition and epidemiology of acute respiratory distress syndrome," Annals of translational medicine, 5, 2017.
[6]. Departemen. kesehatan RI, Profil Data Kesehatan Indonesia Tahun 2010. Jakarta: Kementerian Kesehatan RI, 2012.
[7]. Panti Wilasa Citarum Hospital. Semarang, "Medical Records of Patients with Mechanical Ventilation in the ICU Room 2019" 2019.
[8]. Abbasinia M, Irajpour A, Babaii A, Shamali M, and Vahdatnezhad J, "Comparison the effects of shallow and deep endotracheal tube suctioning on respiratory rate, arterial blood oxygen saturation and number of suctioning in patients hospitalized in the intensive care unit: a randomized controlled trial," Journal of caring sciences, 3, 2014, 157.
[9]. Yousefi H, Vahdatnejad J, and Yazdannik AR, "Comparison of the effects of two levels of negative pressure in open endotracheal tube suction on the physiological indices among patients in intensive care units," Iranian journal of nursing and midwifery research, 19, 2014, 473.
[10]. Nizar AM and Haryati DS, "Effect of Suction on Saturation Levels in Coma Patients in ICU Room Dr. Moewardi Surakarta Hospital in 2015. Journal of Global Nursing. 2(2), 2017.
[11]. Triyono T, Setiyawan S, and Safitri W, " Hemodynamic Status of Patients with Endotrcheal Tube with Pre-Oxygenation before Suction in the Intensive Care Unit. Gaster: Journal of Health. 17(1), 2019, 107-17.
[12]. Robeiro G, Jack L, Scully N, Wilson D. Fundamental of Nursing Clinical Skill Workbook. Jakarta: EGC, 2016.
[13]. Ignatavicius DD, workman ML, " Medical - Surgical Nursing: Patients-centered Collaborative Care," 2015.
[14]. El-Moaty Asmaa M. El-Moaty Abd, El-Mokkadem Naglaa PhD,RN, Abd-Elhy Asmaa H, "Effect of Semi Fowler’s Positions on Oxygenation and Hemodynamic Status among Critically Ill Patients with Traumatic Brain Injury," international Journal of Novel Research in healthcare and nursing, 4, 2017, 227-236.
[15]. Ernawati Ratna, Gerontic Nursing Care. Yogyakarta: PT. Pustaka Baru, 2016.
[16]. Djojodibroto Darmanto, SP. FCCP. , Respirologi Medecine. Jakarta: EGC, 2014.
[17]. Wolfe TJ, Torbey MT, "Management of Intracranial Pressure," Curr Neuro Neurosci, 2009, 477- 85.
[18]. Nakagawa K, Smith WS., "Evaluation and Management of increased Intracranial Pressure," Lifelong Learning Neurol, 17, 2011, 1077-93.
[19]. Amri I, "Management of Increased Intracranial Pressure. Medika Tadulako: Medical Scientific Journal of the Faculty of Medicine and Health Sciences. 4(3), 2017, 1-17.
[20]. Potter. P.A and Perry A G, Nursing Fundamental Textbooks. Jakarta: Salemba Medika; 9, 2016.
[21]. Berman A, Snyder S J, Kozier B, Erb G L, Levett-Jones T, Dwyer T, Hales M, Harvey N, Moxham L, and Park T, Kozier & Erb's Fundamentals of Nursing Australian Edition Pearson Higher Education AU, 3, 2014.
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[23]. Okasha M , Anbar, SK & Seloma AY "Cerebral Oxygenation and Physiological Parameter Among Acute traumatic Brain Injury patinets at supine versus semi-fowler Position," Advances in life science and Technology Journal, 12, 2013, 2224-7181.
[24]. Prato BM, Santos DR, Silva VS, Júnior N, Rivail B, et al., "Influence of different degrees of head elevation on respiratory mechanics in mechanically ventilated patients," Revista Brasileira de terapia intensiva., 27, 2015, 347-52.
[25]. Jacqueline Rodrigues de Freitas Vianna PT PhD, Milea Mara Lourenco da Simoes PT, and Mouricio Jamani PT PhD, "Comparing the Effects of Two Different Level of Hiperoksigenation on Gas Exchange during Open Endotracheal Suctioning: A Randomized Crossover Study," Respitaory Care, 62(1), 2017.
[26]. Departemen. Kesehatan. RI. Indonesia, Klasifikasi berumur Menurut Kategori. jakarta: Direktorat Jenderal Pelayanan Kesehatan, 2009.
[27]. Liu X-W, Jin Y, Ma T, Qu B, and Liu Z, "Differential Effect of Endotrcheal Suctioning on Gas Exchanges in Patients with Acut Respiratory Failure Under Pressure-Controlled and Volume- Controlled Ventilation," Biomed research international, 2015.
[28]. Terry. CL and Weaver. A, Critical Nursing: Demystified 2014.
[29]. Zukhri S, Suciana F, and Herianto A, "Effect of Open System Mucus Suction on Oxygen Saturation in Patients with Ventilators. Motor Journal of Health Sciences. 13(26), 2018.
[30]. Hayati T, Nur BM, Rayasari F, Sofiani Y, and Irawati D, " Comparison of Giving One Minute Hyperoxygenation dan Two Minutes in the Suction Process of Oxygen Saturation in Patients Installed with Ventilators. Journal of Telenursing (JOTING). 1(1), 2019, 67-79.
[31]. Ching Cing Mira Tania Gabriela, "The Effect of Suction Dept and Shollow Suction on Hemodynamic Changes in Patients with Endotracheal Tube in the ICU Room Ulin Hospital Banjarmasin. Health Dynamics. 8(1), 2017.
[32]. Maggiore SM, Lellouche F, Pignataro C, Girou E, Maitre B, Richard J.C.M, Lemaire F, Brun- Buisson C, and. Brochard L, "Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice," Respiratory care, 58, 2013, 1588-1597.
[33]. Hendra. Lesmana, Murni T W, and Anna A, "The Use of Different Pressure of Suction and Its Impact on Oxygen Saturation Among Patients with Head Injury," Jurnal Nursing of Padjadjaran, 3, 2015.
[34]. Piacentini E, Blanch L, and Fernández L, "Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure," Intensive care medicine, 30, 2004, 2210-2215.
[35]. Brunner and Suddarth, Medical Surgical Nursing Textbook. 8 e, editor. Jakarta: EGC; 2017.
[36]. Shah DS, Desai AR, and Gohil N, "A Comparison of Effect of Semi Fowler's vs Side Lying Position on Tidal Volume & pulse Oxymetri in ICU Patients.," Innovative Journal of Medical and Health Science, 2, 2012, 81-85.
[37]. Tavangar Hossein J M, Sobhanian Saeed & Jahromi Forozan fatemeh, "the Effect of Duration of Pre-Oxigenation Before Endotracheal suction on Hemodynamic Symptoms," Global Journal Of Health Science, 9(2), 2017.
[38]. Muhaji, Santoso B, and Putrono, "Comparison Of The Effectiveness Of Two Levels Of Suction Pressure On Oxygen Saturation In Patients With Endotracheal Tube," Belitung Nursing Journal, 3, 2017.
References
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[2]. Price SA, Wilson L.M Guideline, "Endotracheal Suctioning Of Mechanically Ventilated Patients With Artificial Arway," Respitaory Care., 55, 2010, 758-64.
[3]. Opdahl H. (Acute Respiratory Failure Concomitant with Serious Disease or Injury). Tidsskrift for Den Norske Laegeforening: tidsskrift for practice medicin, ny raekke," 2010, 154- 7.
[4]. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, and Esteban A et al, "Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries," Jama, 2016, 788-800.
[5]. Rezoagli E, Fumagalli R, Bellani G, "Definition and epidemiology of acute respiratory distress syndrome," Annals of translational medicine, 5, 2017.
[6]. Departemen. kesehatan RI, Profil Data Kesehatan Indonesia Tahun 2010. Jakarta: Kementerian Kesehatan RI, 2012.
[7]. Panti Wilasa Citarum Hospital. Semarang, "Medical Records of Patients with Mechanical Ventilation in the ICU Room 2019" 2019.
[8]. Abbasinia M, Irajpour A, Babaii A, Shamali M, and Vahdatnezhad J, "Comparison the effects of shallow and deep endotracheal tube suctioning on respiratory rate, arterial blood oxygen saturation and number of suctioning in patients hospitalized in the intensive care unit: a randomized controlled trial," Journal of caring sciences, 3, 2014, 157.
[9]. Yousefi H, Vahdatnejad J, and Yazdannik AR, "Comparison of the effects of two levels of negative pressure in open endotracheal tube suction on the physiological indices among patients in intensive care units," Iranian journal of nursing and midwifery research, 19, 2014, 473.
[10]. Nizar AM and Haryati DS, "Effect of Suction on Saturation Levels in Coma Patients in ICU Room Dr. Moewardi Surakarta Hospital in 2015. Journal of Global Nursing. 2(2), 2017.
[11]. Triyono T, Setiyawan S, and Safitri W, " Hemodynamic Status of Patients with Endotrcheal Tube with Pre-Oxygenation before Suction in the Intensive Care Unit. Gaster: Journal of Health. 17(1), 2019, 107-17.
[12]. Robeiro G, Jack L, Scully N, Wilson D. Fundamental of Nursing Clinical Skill Workbook. Jakarta: EGC, 2016.
[13]. Ignatavicius DD, workman ML, " Medical - Surgical Nursing: Patients-centered Collaborative Care," 2015.
[14]. El-Moaty Asmaa M. El-Moaty Abd, El-Mokkadem Naglaa PhD,RN, Abd-Elhy Asmaa H, "Effect of Semi Fowler’s Positions on Oxygenation and Hemodynamic Status among Critically Ill Patients with Traumatic Brain Injury," international Journal of Novel Research in healthcare and nursing, 4, 2017, 227-236.
[15]. Ernawati Ratna, Gerontic Nursing Care. Yogyakarta: PT. Pustaka Baru, 2016.
[16]. Djojodibroto Darmanto, SP. FCCP. , Respirologi Medecine. Jakarta: EGC, 2014.
[17]. Wolfe TJ, Torbey MT, "Management of Intracranial Pressure," Curr Neuro Neurosci, 2009, 477- 85.
[18]. Nakagawa K, Smith WS., "Evaluation and Management of increased Intracranial Pressure," Lifelong Learning Neurol, 17, 2011, 1077-93.
[19]. Amri I, "Management of Increased Intracranial Pressure. Medika Tadulako: Medical Scientific Journal of the Faculty of Medicine and Health Sciences. 4(3), 2017, 1-17.
[20]. Potter. P.A and Perry A G, Nursing Fundamental Textbooks. Jakarta: Salemba Medika; 9, 2016.
[21]. Berman A, Snyder S J, Kozier B, Erb G L, Levett-Jones T, Dwyer T, Hales M, Harvey N, Moxham L, and Park T, Kozier & Erb's Fundamentals of Nursing Australian Edition Pearson Higher Education AU, 3, 2014.
[22]. Deye N, Lellouche F, Maggiore S M, Taillé S, Demoule A, L’her E, Galia F, Harf A, Mancebo J, and Brochard L, "The semi-seated position slightly reduces the effort to breathe during difficult weaning," Intensive care medicine, 39, 2013, 85-92.
[23]. Okasha M , Anbar, SK & Seloma AY "Cerebral Oxygenation and Physiological Parameter Among Acute traumatic Brain Injury patinets at supine versus semi-fowler Position," Advances in life science and Technology Journal, 12, 2013, 2224-7181.
[24]. Prato BM, Santos DR, Silva VS, Júnior N, Rivail B, et al., "Influence of different degrees of head elevation on respiratory mechanics in mechanically ventilated patients," Revista Brasileira de terapia intensiva., 27, 2015, 347-52.
[25]. Jacqueline Rodrigues de Freitas Vianna PT PhD, Milea Mara Lourenco da Simoes PT, and Mouricio Jamani PT PhD, "Comparing the Effects of Two Different Level of Hiperoksigenation on Gas Exchange during Open Endotracheal Suctioning: A Randomized Crossover Study," Respitaory Care, 62(1), 2017.
[26]. Departemen. Kesehatan. RI. Indonesia, Klasifikasi berumur Menurut Kategori. jakarta: Direktorat Jenderal Pelayanan Kesehatan, 2009.
[27]. Liu X-W, Jin Y, Ma T, Qu B, and Liu Z, "Differential Effect of Endotrcheal Suctioning on Gas Exchanges in Patients with Acut Respiratory Failure Under Pressure-Controlled and Volume- Controlled Ventilation," Biomed research international, 2015.
[28]. Terry. CL and Weaver. A, Critical Nursing: Demystified 2014.
[29]. Zukhri S, Suciana F, and Herianto A, "Effect of Open System Mucus Suction on Oxygen Saturation in Patients with Ventilators. Motor Journal of Health Sciences. 13(26), 2018.
[30]. Hayati T, Nur BM, Rayasari F, Sofiani Y, and Irawati D, " Comparison of Giving One Minute Hyperoxygenation dan Two Minutes in the Suction Process of Oxygen Saturation in Patients Installed with Ventilators. Journal of Telenursing (JOTING). 1(1), 2019, 67-79.
[31]. Ching Cing Mira Tania Gabriela, "The Effect of Suction Dept and Shollow Suction on Hemodynamic Changes in Patients with Endotracheal Tube in the ICU Room Ulin Hospital Banjarmasin. Health Dynamics. 8(1), 2017.
[32]. Maggiore SM, Lellouche F, Pignataro C, Girou E, Maitre B, Richard J.C.M, Lemaire F, Brun- Buisson C, and. Brochard L, "Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice," Respiratory care, 58, 2013, 1588-1597.
[33]. Hendra. Lesmana, Murni T W, and Anna A, "The Use of Different Pressure of Suction and Its Impact on Oxygen Saturation Among Patients with Head Injury," Jurnal Nursing of Padjadjaran, 3, 2015.
[34]. Piacentini E, Blanch L, and Fernández L, "Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure," Intensive care medicine, 30, 2004, 2210-2215.
[35]. Brunner and Suddarth, Medical Surgical Nursing Textbook. 8 e, editor. Jakarta: EGC; 2017.
[36]. Shah DS, Desai AR, and Gohil N, "A Comparison of Effect of Semi Fowler's vs Side Lying Position on Tidal Volume & pulse Oxymetri in ICU Patients.," Innovative Journal of Medical and Health Science, 2, 2012, 81-85.
[37]. Tavangar Hossein J M, Sobhanian Saeed & Jahromi Forozan fatemeh, "the Effect of Duration of Pre-Oxigenation Before Endotracheal suction on Hemodynamic Symptoms," Global Journal Of Health Science, 9(2), 2017.
[38]. Muhaji, Santoso B, and Putrono, "Comparison Of The Effectiveness Of Two Levels Of Suction Pressure On Oxygen Saturation In Patients With Endotracheal Tube," Belitung Nursing Journal, 3, 2017.
[2]. Price SA, Wilson L.M Guideline, "Endotracheal Suctioning Of Mechanically Ventilated Patients With Artificial Arway," Respitaory Care., 55, 2010, 758-64.
[3]. Opdahl H. (Acute Respiratory Failure Concomitant with Serious Disease or Injury). Tidsskrift for Den Norske Laegeforening: tidsskrift for practice medicin, ny raekke," 2010, 154- 7.
[4]. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, and Esteban A et al, "Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries," Jama, 2016, 788-800.
[5]. Rezoagli E, Fumagalli R, Bellani G, "Definition and epidemiology of acute respiratory distress syndrome," Annals of translational medicine, 5, 2017.
[6]. Departemen. kesehatan RI, Profil Data Kesehatan Indonesia Tahun 2010. Jakarta: Kementerian Kesehatan RI, 2012.
[7]. Panti Wilasa Citarum Hospital. Semarang, "Medical Records of Patients with Mechanical Ventilation in the ICU Room 2019" 2019.
[8]. Abbasinia M, Irajpour A, Babaii A, Shamali M, and Vahdatnezhad J, "Comparison the effects of shallow and deep endotracheal tube suctioning on respiratory rate, arterial blood oxygen saturation and number of suctioning in patients hospitalized in the intensive care unit: a randomized controlled trial," Journal of caring sciences, 3, 2014, 157.
[9]. Yousefi H, Vahdatnejad J, and Yazdannik AR, "Comparison of the effects of two levels of negative pressure in open endotracheal tube suction on the physiological indices among patients in intensive care units," Iranian journal of nursing and midwifery research, 19, 2014, 473.
[10]. Nizar AM and Haryati DS, "Effect of Suction on Saturation Levels in Coma Patients in ICU Room Dr. Moewardi Surakarta Hospital in 2015. Journal of Global Nursing. 2(2), 2017.
[11]. Triyono T, Setiyawan S, and Safitri W, " Hemodynamic Status of Patients with Endotrcheal Tube with Pre-Oxygenation before Suction in the Intensive Care Unit. Gaster: Journal of Health. 17(1), 2019, 107-17.
[12]. Robeiro G, Jack L, Scully N, Wilson D. Fundamental of Nursing Clinical Skill Workbook. Jakarta: EGC, 2016.
[13]. Ignatavicius DD, workman ML, " Medical - Surgical Nursing: Patients-centered Collaborative Care," 2015.
[14]. El-Moaty Asmaa M. El-Moaty Abd, El-Mokkadem Naglaa PhD,RN, Abd-Elhy Asmaa H, "Effect of Semi Fowler’s Positions on Oxygenation and Hemodynamic Status among Critically Ill Patients with Traumatic Brain Injury," international Journal of Novel Research in healthcare and nursing, 4, 2017, 227-236.
[15]. Ernawati Ratna, Gerontic Nursing Care. Yogyakarta: PT. Pustaka Baru, 2016.
[16]. Djojodibroto Darmanto, SP. FCCP. , Respirologi Medecine. Jakarta: EGC, 2014.
[17]. Wolfe TJ, Torbey MT, "Management of Intracranial Pressure," Curr Neuro Neurosci, 2009, 477- 85.
[18]. Nakagawa K, Smith WS., "Evaluation and Management of increased Intracranial Pressure," Lifelong Learning Neurol, 17, 2011, 1077-93.
[19]. Amri I, "Management of Increased Intracranial Pressure. Medika Tadulako: Medical Scientific Journal of the Faculty of Medicine and Health Sciences. 4(3), 2017, 1-17.
[20]. Potter. P.A and Perry A G, Nursing Fundamental Textbooks. Jakarta: Salemba Medika; 9, 2016.
[21]. Berman A, Snyder S J, Kozier B, Erb G L, Levett-Jones T, Dwyer T, Hales M, Harvey N, Moxham L, and Park T, Kozier & Erb's Fundamentals of Nursing Australian Edition Pearson Higher Education AU, 3, 2014.
[22]. Deye N, Lellouche F, Maggiore S M, Taillé S, Demoule A, L’her E, Galia F, Harf A, Mancebo J, and Brochard L, "The semi-seated position slightly reduces the effort to breathe during difficult weaning," Intensive care medicine, 39, 2013, 85-92.
[23]. Okasha M , Anbar, SK & Seloma AY "Cerebral Oxygenation and Physiological Parameter Among Acute traumatic Brain Injury patinets at supine versus semi-fowler Position," Advances in life science and Technology Journal, 12, 2013, 2224-7181.
[24]. Prato BM, Santos DR, Silva VS, Júnior N, Rivail B, et al., "Influence of different degrees of head elevation on respiratory mechanics in mechanically ventilated patients," Revista Brasileira de terapia intensiva., 27, 2015, 347-52.
[25]. Jacqueline Rodrigues de Freitas Vianna PT PhD, Milea Mara Lourenco da Simoes PT, and Mouricio Jamani PT PhD, "Comparing the Effects of Two Different Level of Hiperoksigenation on Gas Exchange during Open Endotracheal Suctioning: A Randomized Crossover Study," Respitaory Care, 62(1), 2017.
[26]. Departemen. Kesehatan. RI. Indonesia, Klasifikasi berumur Menurut Kategori. jakarta: Direktorat Jenderal Pelayanan Kesehatan, 2009.
[27]. Liu X-W, Jin Y, Ma T, Qu B, and Liu Z, "Differential Effect of Endotrcheal Suctioning on Gas Exchanges in Patients with Acut Respiratory Failure Under Pressure-Controlled and Volume- Controlled Ventilation," Biomed research international, 2015.
[28]. Terry. CL and Weaver. A, Critical Nursing: Demystified 2014.
[29]. Zukhri S, Suciana F, and Herianto A, "Effect of Open System Mucus Suction on Oxygen Saturation in Patients with Ventilators. Motor Journal of Health Sciences. 13(26), 2018.
[30]. Hayati T, Nur BM, Rayasari F, Sofiani Y, and Irawati D, " Comparison of Giving One Minute Hyperoxygenation dan Two Minutes in the Suction Process of Oxygen Saturation in Patients Installed with Ventilators. Journal of Telenursing (JOTING). 1(1), 2019, 67-79.
[31]. Ching Cing Mira Tania Gabriela, "The Effect of Suction Dept and Shollow Suction on Hemodynamic Changes in Patients with Endotracheal Tube in the ICU Room Ulin Hospital Banjarmasin. Health Dynamics. 8(1), 2017.
[32]. Maggiore SM, Lellouche F, Pignataro C, Girou E, Maitre B, Richard J.C.M, Lemaire F, Brun- Buisson C, and. Brochard L, "Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice," Respiratory care, 58, 2013, 1588-1597.
[33]. Hendra. Lesmana, Murni T W, and Anna A, "The Use of Different Pressure of Suction and Its Impact on Oxygen Saturation Among Patients with Head Injury," Jurnal Nursing of Padjadjaran, 3, 2015.
[34]. Piacentini E, Blanch L, and Fernández L, "Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure," Intensive care medicine, 30, 2004, 2210-2215.
[35]. Brunner and Suddarth, Medical Surgical Nursing Textbook. 8 e, editor. Jakarta: EGC; 2017.
[36]. Shah DS, Desai AR, and Gohil N, "A Comparison of Effect of Semi Fowler's vs Side Lying Position on Tidal Volume & pulse Oxymetri in ICU Patients.," Innovative Journal of Medical and Health Science, 2, 2012, 81-85.
[37]. Tavangar Hossein J M, Sobhanian Saeed & Jahromi Forozan fatemeh, "the Effect of Duration of Pre-Oxigenation Before Endotracheal suction on Hemodynamic Symptoms," Global Journal Of Health Science, 9(2), 2017.
[38]. Muhaji, Santoso B, and Putrono, "Comparison Of The Effectiveness Of Two Levels Of Suction Pressure On Oxygen Saturation In Patients With Endotracheal Tube," Belitung Nursing Journal, 3, 2017.