Systematic review of the oxy-hemodynamic effects of bath in hospitalized critical adults

 Author: Dalmo Valério Machado de Lima, RN, PhD, Nursing Professor. Medical-Surgical Nursing Department, Aurora Afonso Costa Nursing School, Fluminense Federal University, Rio de Janeiro, Brazil

 Advisor: Rubia Aparecida Lacerda, RN, PhD, Nursing Professor. Medical-Surgical Nursing Department, Nursing School, São Paulo University, São Paulo, Brazil

 Bibliografic reference: Lima DVM. Oxy-hemodynamic effects of bath in hospitalized adult patients in critical condition: evidence for the systematic review of literature [thesis]. São Paulo (SP), Brazil: Nursing School, São Paulo University; 2009.

 Problem: The bath of the patient in critical state is an activity that requires several stages of planning, because of the characteristics and peculiarities. The peculiar technological apparatus of high complexity units allow for monitoring, but difficult access and mobilization of the patient. The oxy-hemodynamic effects of bath in hospitalized adult patients in critical condition in context on etiology / damage were investigated by this systematic review of literature.

 Objective: Identifying the existence of scientific evidence about these impacts on that population and; verifying the possibility of establishment of criteria for bath’s indication in different clinical situations.

 Method: Systematic review of literature without meta-analysis from primary and secondary studies with explicit methodology, without clipping on languages or predetermined time. The inclusion criteria involved the measurement of hemodynamic or oxymetric variable during the bath of hospitalized adults in critical care units. It was used an adaptation of the PICO strategy, the PIO, where: P (patients, problem) = "Intensive Care Units" and variations, I (intervention) = bath and variations, O (outcome) = "Hemodynamic Phenomena" / "Oxygen Consumption "and variations. It was investigated: the electronic databases CINAHL, DEDALUS, EMBASE, Cochrane Library, LILACS, PubMed / MEDLINE; manually the libraries of the Nursing Schools of Universidade Federal Fluminense and Universidade Federal do Rio de Janeiro; cross references of publications and; related articles of Pubmed and ISI.

 Results: The 44,597 initial results of the electronic databases were exported to a program for managing references, submitted to successive filters, resulting in 23 publications which, added to two monographs obtained in conventional libraries, totalize 25 references. After reading full publications and having consensus meetings, 19 studies were discarded, totalizing a sample of 6 publications. Results explained the low publication on the subject, with a predominance of national studies. In view of the fragility and heterogeneity of the studies, it was not possible to do a consistent mapping of all the important oximetric and hemodynamic answers for these patients. The further discussed outcomes were the mixed venous oxygen saturation and heart rate, representatives of the respective segments. With the exception of saturation, it was not identified important differences when compared to the baselines. The saturation declined during the bath and was restored after 30 minutes at the end.

 Conclusion: It is concluded that operational measures seem act as risk factors: bath in less than 4 hours after cardiac surgery, prolonged positioning in lateral decubitus and shower’s time over 20 minutes or; a protective factor: maintenance of water temperature at 40° C. As the findings were derived from quasi-experiments, their evidences were qualified to level C for Oxford and scored between 11 and 18 by the check list of Downs & Black, that showed an association between higher scores and better control of internal validity. It is suggested the use of strategies that maximize the indications of protection and other that minimize the indications of risk.

 Keywords: Baths; Nursing Care; Hemodynamic; Evidence-Based Medicine; Oxymetry, Intensive Care Units.

 Main bibliography:

1. Atkins PJ, Hapshe E, Riegel B. Effects of a bedbath on mixed venous oxygen saturation and heart rate in coronary artery bypass graft patients. Am J Crit Care 1994; 3(2): 107-15.

2. [homepage on the internet]. Oxford: Centre for Evidence-Based Medicine; [updated 2001 May; cited 2008 Sep 30]. Available from:

3. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998; 52(6) 377-84.

4. Hayashida M, Ogawa K, Kawashima Y, Isoda R, Sato M, Fujimura C, Yoneyama T, Sawamura S. Does mixed venous desaturation during a bed bath indicate cardiopulmonary descompensation in postoperative cardiac patients? Masui 1998; 47(8):933-938.

5. Lima DVM. O banho na unidade de terapia intensiva: conceitos e preconceitos – a ciência subsidiando um cuidado de enfermagem [dissertação]. Rio de Janeiro: Escola de Enfermagem Alfredo Pinto, Universidade Federal do Estado do Rio de Janeiro; 2002.


Fellowship: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / “Foundation of Support Research of the Sao Paulo State”

Address for correspondence: Dalmo Valério Machado de Lima, Medical-Surgical Nursing Department, Aurora Afonso Costa Nursing School, Fluminense Federal University, Rua Dr. Celestino, 74, Centro, Niterói, RJ, Brazil. CEP: 24020-091 - - Telefone: +55 (21) 2629-9477