The effects of different degrees of head-of-bed elevation on the respiratory pattern and drainage following thyroidectomy: a randomized controlled trial

BACKGROUND: The patient's position is important for ensuring patient comfort and preventing complications after thyroidectomy. OBJECTIVES: This study was carried out to determine the effects of different degrees of head-of-bed elevation (HOBE) on the respiratory pattern and drainage following thyroidectomy and to provide suggestions for evidence-based clinical practice. METHODS: The sample of this prospective, parallel arm, randomized controlled trial included 114 patients undergoing thyroidectomy in a university hospital in Turkey. The patients were randomly assigned (1:1:1) to supine 0° (baseline), 30° and 45° HOBE groups. Respiratory pattern including respiratory rate (RR), peripheral oxygen saturation (SpO(2)) and dyspnea, and drainage including amount of drainage and hematoma formation were evaluated at the 1(rd), 2(rd), 3(rd) and 4(th) hours following thyroidectomy. RESULTS: The majority of the patients (83.3%) were female and 84.2% had undergone total thyroidectomy. The mean RR (18.47, 95% CI=17.85–19.09) of the patients in the supine 30° HOBE group at the 1(rd) hour was significantly higher than that of the patients in the supine 0° group (17.32, 95% CI=16.88–17.76; p<0.05). There was no significant difference between the SpO(2) values of the patients in the groups (p>0.05). The amount of drainage was significantly higher in the supine 0° group at the 2nd hour than that of the patients in the supine 45° HOBE group (5.92±5.18; 3.34±5.56 respectively; p<0.05). None of the patients in the groups had hematoma formation. While no patient in the supine 30° HOBE group had dyspnea, dyspnea occurred in 9 patients in the supine 0° group and in 3 patients in the supine 45° HOBE group. CONCLUSION: This study showed that different HOBE positions resulted in clinically insignificant changes on the RR and amount of drainage during the first 4 hours following thyroidectomy but did not affect SpO(2) value.