6.

3 PROBLEM STATEMENT
Effectiveness of hypertonic saline nebulized suctioning on airway clearance and
prevention of ventilator associated pneumonia [vap] among patients connected to
mechanical ventilator in medical and surgical intense care units at a selected
hospitals, chinnakakani, Guntur district, Andhra Pradesh.

6.4 OBJECTIVE OF THE STUDY:

1. To assess the airway clearance and prevention of ventilator associated pneumonia

[vap] before administering hypertonic saline nebulized suctioning in both
experimental and control groups.
2. To evaluate the effectiveness of hypertonic saline neublized suctioning on airway
clearance and prevention of ventilator associated pneumonia among patience
connected to mechanical ventilator in experimental group and without intervention in
control group.
3. To determine the association between post-observational score with selected variables
among experimental group

6.5 SELECTED VARIABLES:

The selected variables are

 Age
 Gender
 Occupation
 Income
 No. of days on ventilator
 Sp02 Levels
 ABG Bicarb levels

6.6 OPERATIONAL DEFINITIONS:

1. Effectiveness: It refers to the degree to which the hypertonic saline nebulisation
has achieved desired effect in improving the airway clearance and prevention of VAP
among mechanical ventilated patients

2. Hypertonic saline nebulized suctioning: It refers a saline which is strong sterile

solution of salt water that can be inhaled as nebulized mechanically ventilated patients
to maintain airway clearance. This solution acts as mycolytic expertorants,
mucokinetics , ion transport modifier and muco regulatory compound.

3. Airway clearance: In this study, it refers to define airway clearance the technique
used to clear the mucus from the lungs by using hypertonic saline.
 4. Prevention: In this study it refers to to intended to decrease the risk of ventilated
associated phenomena by using hypertonic saline nebulized suctioning connected to
mechanical ventilator.

5. Ventilator associated phenomena: In this study, it refers to that is a type of lung

infection the occurs in patients who are on mechanical ventilator.

6. Mechanical ventilator: In this study, it refers to technique through which gas is

moved towards and from the lungs through an external device directly connected to
the patients via endotracheal tubing.

7. Medical and surgical intensive care unit: In this study, it refers that critical care
services meet the need of patients facing an intermediate life threatening health
condition chosen by the researcher to conduct the study.

8. Selected Hospital: It reference to carefully chosen by place by the researcher to

conduct the study. In the present study NRI General hospital, Chinnakakani, Guntur
District, Andhra Pradesh Is selected for conducting study.

6.7 OPERATIONAL DEFINITIONS OF SELECTED VARIABLES:

1. Age: It refers to chronological age of ventilated patients for the present study it is
categorized as:

a) 21-40 years

b) 41-60 years

c) And above

2. Gender: It refers to the identification and specification of the sex of the ventilated
patients for the present study

a) Male

b) Female

3. Occupation: It refers to the job profession of the ventilated patients for the present
study is categorized as

a) Business

b) Private Employee

c) Government employee

d) Un-employee

4. Income: It refers to the monthly earning of the patients and the following ranges
of income, take for the present study
 a) Less the Rs 5000 per month

b) Rs 5000 – 10000 per month

c) Rs 10000 – 15000 per month

d) Rs 15000 and above

5. No of days on ventilator: It refers to the days of ventilation required for the

ventilated patient for the present study

a) 2 days

b) 3 days

c) 4 days

d) Above 7 days

6. Spo2 Levels: It refers to the saturation levels of oxygen required for the ventilated
patients for the preset study

a) Below 90%

b) 90-95%

c) Above 95%

7. ABG Bicarb levels: It refers to the analysis of ABG (Arterial blood gas) Bicarb
levels on ventilated patient for the present study

a) Below 7.38%

b) 7.38% - 7.42%

c) Above 7.45%

6.8 HYPOTHESIS:
H1: Significant difference will be there between pre observational and post
observational score on effectiveness of hypertonic saline nebulized suctioning on
airway clearance and prevention of VAP among mechanical ventilated patients

H2: Significant association will be there between the post observational score with
their selected variables in experimental group.

6.9 DELIMITATIONS:
The present study is delimited to the mechanical ventilated patients
  Both male and female patients who are connected to the mechanical ventilator
in medical and surgical intensive care unit at a selected hospital,
chinnakakani, Guntur District, Andhra Pradesh.
 With age of above 21 years
 Who are willing to participate in the study
 Both conscious and unconscious patients

6.10 PROJECTED OUTCOME:

The result of the study evaluating the efficacy of hypertonic saline nebulized
suctioning on airway clearance on prevention of ventilator- associated phenomena.
This information will help to choose the cause effective and easiest way in maintain
the airway patency of patient and prevention of ventilated-associated phenomena
connected to mechanical ventilator and thus the physiological parameters will be
stable and the study will show difference in the effectiveness of the therapy in both
the groups and on another hand the association between the post observation score of
experimental group with selected variable can be elected which will help the future
researcher to do the research and put into the clinical practice.

7.0 MATERIALS AND METHODS:

7.1 Sources of data:

a) Research Design: Research design adopted for the study is experimental design.

b) Setting of the study: The study will be conducted in medical and surgical
intensive care unit of selected hospital, Chinnakakani, Guntur District, Andhra
Pradesh.

c) Population: The target population for the present study mechanically ventilated
patients with the age group above 21 years.

d) Sample: The sample for the study will be 60 samples (N= 30 experimental group,
N= 30 Control group)

e) Sample technique: The sample technique for the study is systematic random
sampling technique.

CRITERIA SAMPLE SELECTION

f) Inclusion Criteria: The study includes mechanically ventilated patients admitted in
medical and surgical intensive care unit of selected hospital, chinnakakani, Guntur
District, Andhra Pradesh.
  Selected age group is above 21 years
 Both male and females
 Both conscious and unconscious patients
 Mechanically ventilated patients admitted in Medical and surgical intensive
care unit in selected hospital
 Subjects who are available at the time of data collection

g) Exclusion criteria: The study excludes mechanically ventilated patients who are

 Selected age below 2 Years

 Transgender are excluded
 Patients with respiratory complication [Pnemothorax]
 Mechanical ventilated patient admitted other than medical and surgical
intensive care unit
 Subjects who are not available at the time of data collection

7.2 DATA COLLECTION INSTRUMENTS

It consists of two parts namely section-A, Section-B,

Section-A: 1. Includes socio – demographic data

2. Includes clinical data

Section-B: Tools to measure the bio-physiological parameters of the mechanically

ventilated patients

INTEVENTIONAL PROTOCAL
For experimental group the hypertonic saline nebulized suctioning will be done every
2nd Interval and where as in the control group the isotonic saline nebulized suctioning
will be done every 2nd Interval

7.3 DATA COLLECTION METHOD

 Formal permission will be obtained from concerned authorities
 Informed return consent will be obtained from the sample or subject
 Ethical clearance will be obtained from the institutional ethical committee
 The researcher will be personally collecting the socio demographic data,
Clinical data, bio-physiological parameter before and after the administration
of hypertonic saline nebulisation

7.4 PLAN FOR DATA ANALYSIS

 The data obtained will be analysed in-terms of objectives and will be analysed by descriptive
and inferential statistics

DESCRIPTIVE STATISTICS

 Frequency and percentage will be used to summarize the sample

characteristics
 Mean, Standard deviation Will be calculated for post interventional score

INFERENTIAL STATISTICS
 Paired ‘t’ Test will be used to evaluate the effectiveness of hypertonic saline
nebulized suctioning
 Chi-Square test will be used to find out the association between the post-
interventional score with the selected socio-demographic variables
 Anova will be concluded to test the differences among the group means in the
selected subjects [Experimental and control group]

7.5 DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE

CONDUCTED TO PATIENTS OR OTHER ANIMAL IF SO,
PLEASE DESCRIBE BRIEFLY?
Yes, as the study is experiential in nature with intervention hypertonic saline
nebulized suctioning

7.6 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTIUTION?
Yes, Ethical clearance has been obtained from concerned authorities.