Investigation of Treatment Modalities of Pulmonary Oedema: A Retrospective Study

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dc.contributor.advisor Jull, A en
dc.contributor.advisor Slark, J en Sharma, Sherard en 2016-11-15T20:14:48Z en 2016 en
dc.identifier.uri en
dc.description Full text is available to authenticated members of The University of Auckland only. en
dc.description.abstract Introduction: Pulmonary oedema is a common and important finding in acute heart failure. It also encompasses high mortality and morbidity. The management of pulmonary oedema from nurses’ perspective and dose ranges for glyceryl trinitrate is poorly defined. Methods: The purpose of this thesis was to investigate the effects of two treatment pathways which were Glyceryl Trinitrate (GTN) and non GTN pathways for cardiogenic pulmonary oedema (CPO) on patients’ vital signs, 60-day mortality, hospital length of stay and need for ventilation. This study was a retrospective design chart audit conducted from January 2014 to May 2015 in cardiac care unit, Waikato District Health Board. Results: 62 patients met the inclusion criteria. Higher doses of glyceryl trinitrate contributed to significantly greater improvement in oxygen saturation levels than non-glyceryl trinitrate at all three time points (at 30 minutes, 95% CI, -4.4 to -0.8, (p<0.01), at 60 minutes, 95% CI, -5.7 to -2.1, (p<0.0001) and at 24 hours, 95% CI, -5.0 to -1.2, (p<0.0001) respectively). High doses of glyceryl trinitrate also contributed to improved respiration rates when compared with the nonglyceryl trinitrate pathway (at 30 minutes, 95% CI, 0.3 to 2.7, (p=0.01), at 60 minutes, 95% CI, 1.1 to 4.1, (p=0.002) and at 24 hours, 95% CI, 1.8 to 4.4, (p<0.0001) respectively). There were also significant differences in the reduction in heart rates in the glyceryl trinitrate pathway when compared with the non-glyceryl trinitrate pathway at 60 minutes and 24 hours (95% CI, 7.4 to 29.0, (p=0.002) and 95% CI, 5.1 to 25.0, (p=0.003) respectively). The participants in the glyceryl trinitrate group had greater reduction in systolic blood pressure than the non-glyceryl trinitrate group at time points 30 minutes, 95% CI, 3.73 to 13.94, (p=0.001), at 60 minutes, 95% CI, 2.76 to 15.01, (p=0.005) and at 24 hours, 95% CI, 12.87 to 29.63, (p<0.0001). Conclusion: Administration of GTN is associated with reduction in respiration rate, heart rate, systolic blood pressure and increase in oxygen saturation in patients with cardiogenic pulmonary oedema. It should be used more often in these population and doses should be escalated to achieve therapeutic blood pressure. This study was limited by its small sample size and more adequately powered studies are needed to establish the relationship of the treatments to patient outcomes. Studies that focus on defining the CPO population are also necessary. en
dc.publisher ResearchSpace@Auckland en
dc.relation.ispartof Masters Thesis - University of Auckland en
dc.relation.isreferencedby UoA99264891111202091 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights Restricted Item. Available to authenticated members of The University of Auckland. en
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dc.rights.uri en
dc.title Investigation of Treatment Modalities of Pulmonary Oedema: A Retrospective Study en
dc.type Thesis en Nursing en The University of Auckland en Masters en
dc.rights.holder Copyright: The author en
pubs.elements-id 546081 en
pubs.record-created-at-source-date 2016-11-16 en

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