Chapter-v

Discussion
 CHAPTER-5

DISCUSSION

This chapter deals with the discussion of the study findings and the results.
The discussion brings the right report to closure. This is the most important section
of any research report. Mechanical ventilation is often a lifesaving, but like other
interventions, it is not without complications. Some of the complications are
hypotension, pneumothorax, decreased cardiac output, nosocomial pneumonia,
aspiration, renal injury.

Pneumonia is a leading cause of death due to hospital acquired infections.

Patients in the intensive care unit (ICU) are at risk for dying not only from their
critical illness but also secondary processes such as nosocomial infection. Hospital
acquired pneumonia is the second most common nosocomial infection in critically
ill patients, affecting 27% of all critically ill patients. Focus has now shifted to
maintenance of airway clearance and prevention of ventilator associated
pneumonia.

Hypertonic saline is a strong sterile solution of salt water that can be

inhaled as a nebulized medication is having mucolytic effect by disrupting ionic
bonds within the mucus gel, which could reduce cross- linking and entanglements.
The studies had shown that hypertonic saline nebulized suctioning facilitates
airway clearance and reduces biofilm formation by pseudomonas aeruginosa and
the production of associated virulence factors thereby preventing the ventilator
associated pneumonia.
5.1: Distribution of selected variables of the patients connected to mechanical
ventilator.

5.2: Distribution of the scores of patients connected to mechanical ventilator.

5.3: Comparison of the pre-interventional and post-interventional scores of patients

connected to mechanical ventilator.

5.4: Association between the post-interventional scores of the patients connected

to mechanical ventilator with their selected variables.

5.1 Discussion on Distribution of selected variables of the patients connected

to mechanical ventilator

This section deals with frequency and percentage distribution of patients

among experimental and control group connected to mechanical ventilator in
medical and surgical intensive care units at a selected hospitals , Chinakakani,
Guntur district, AP. The sample characteristics selected for the present study were
socio demographic variables i.e. age, gender, history of smoking, duration of
admission in hospital, history of respiratory illness, if yes, how long suffering with
respiratory illness.

The present study results had shown that the majority majority 9 (60%) in
experimental group and 6 (40%) in control group were in the age group of 41-50
years. It was supported by a study conducted by Dr. Metilda (2020) to assess the
effect of nebulized suctioning with 3% hypertonic saline for mechanically
ventilated patient on airway clearance also shown that majority 33.3% were
between the age of 41-50 years.

With regard to gender majority 10(66.6%) were males in both the

experimental and control groups. This was supported by Dr. Metilda (2020) to
assess the effect of nebulized suctioning with 3% hypertonic saline for
mechanically ventilated patient on airway clearance also reported that majority
14(57%) were males.
 The clinical variables selected for the present study were type of diagnosis,
no. of days on ventilation, size of the endotracheal tube, frequency of suctioning,
patient position during suctioning, frequency of nebulization, type of tracheal
secretion, peak inspiratory pressure, tidal volume, positive end respiratory
pressure, fraction of inspirated oxygen.

In relation to no. of days on ventilation in the experimental group, majority

53.3% and 66.6% among control group were for 4-6 days. This was supported by
a study conducted by Dr. Metilda (2020) to assess the effect of nebulized
suctioning with 3% hypertonic saline for mechanically ventilated patient on airway
clearance majority 63% were in less than 21 days on mechanical ventilator.

With regard to frequency of suctioning, in experimental group, majority

(53.3%) had 2nd hourly. This was supported by a study conducted by Dr. Metilda
(2020) where majority 43% of them were suctioning every 2 hours.

In concern to patient position during suctioning majority (53.3%) were of

supine position and this was supported by study conducted by Dr. Metilda (2020)
where majority 60% were in supine position while suctioning in experimental
group.

5.2: Discussion on distribution of the scores of patients connected to

mechanical ventilator.

In relation to scores assessed by level of airway clearance scale in pre

intervention of experimental group majority 9(60%) had minimal airway clearance
where in the post intervention majority 10(66.6%) had moderate airway clearance.
This was supported by Dr. Metilda (2020) in which pre intervention majority 60%
had minimal airway clearance and in the post intervention majority 63% had
normal airway clearance.
5.3: Discussion on Comparison of the pre-interventional and post-
interventional scores of patients connected to mechanical ventilator.

In the pre intervention the mean score of airway clearance is 12.6 with a
standard deviation of 2.67 where as in post intervention mean score of airway
clearance is 8 with a standard deviation of 2.44 which shows that there is improved
airway clearance in the experimental group. The calculated paired‘t’ of airway
clearance is 7.3 which was found significant at 0.05 level of significance. This
shown that hypertonic saline nebulized suctioning is effective in facilitating airway
clearance.

This was supported by Dr. Metilda (2020) in which the pre-test mean score
was 7.96 with 3.34 standard deviation and post-test mean score 2.74 with 2.93
standard deviation and the paired t value was 8.46 which noted that there was a
highly significant effectiveness of the intervention.

In relation to ventilator associated pneumonia pre interventional mean score

of clinical pulmonary infection is 4.6 with a standard deviation of 1.77 while mean
score of clinical pulmonary infection score is 2.6 with a standard deviation of 3.27.
The calculated paired‘t’ of clinical pulmonary infection is 4.79 which was found
significant at 0.05 level of significance which shows that hypertonic saline
nebulized suctioning prevents the ventilator associated pneumonia.

5.4: Discussion on association between the post-interventional scores of the

patients connected to mechanical ventilator with their selected variables.

In relation to association between the pre- interventional airway clearance

and socio demographic data, none of them was found significant at 0.05 level of
significance.