الفهرس 
DedicationOnly 14 pages are availabe for public view
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Abstract
Summary
The acid-base imbalances are commonly encountered in clinical
practice, especially in critical care units. Identification of the specific
acid-base imbalance is essential in ascertaining the underlying cause of
the disorder and determining appropriate treatment. For identification of
the primary disturbance, the analysis of blood gas values must be
considering the patient’s history and physical findings, and with an
understanding of expected compensatory responses.
Critically ill patients commonly experienced acid-base imbalances.
Such imbalances can be life-threatening and require rapid correction.
Nurses play an essential role in the early detection of high-risk clients
with an acid-base imbalance in critical care units. Determining a specific
imbalance at present and identifying the nature of the imbalance along
with its severity, etiology, and defining characteristics or assessment
findings.
The present study aimed to explore the risk factors and common
types of acid-base imbalance for critically ill patients in intensive care
units. A descriptive research design was designed to fulfill the aim of
this study. The design was used to explore the risk factors and common
types of acid-base disorders among critically ill patients. The study was
carried out in the Trauma Intensive Care Unit (6 beds), general Intensive
Care Unit (14 beds), and Critical Care Unit (6 beds) at Assuit University
Hospital. A purposive sample of adult male and female critically ill
patients admitted consecutively to the places mentioned above of ICUs
between October 2018 and June 2019. The tools used in this study
consisted of three main tools:
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Tool one: Critically Ill Patients characteristics:
The researcher developed this tool after reviewing the relevant
national and international literature to assess the patient’s demographic
data, and health-relevant data, it comprised of the following parts.
Part I- Personal and clinical data: Included patient’s gender, age,
causes of ICU admission, type of admission, place before admission, unit
of admission, presence of comorbidities, past medical history, date of
admission, date of discharge, length of ICU stay, discharge status, and
current medications.
Part II: Vital signs and Hemodynamic parameter Assessment
sheet: Vital signs included temperature, heart rate, respiratory rate, blood
pressure, mean arterial blood pressure, peripheral capillary oxygen
saturation, Central venous pressure, urine output, pain score, and
Glasgow coma scale (GCS). The vital signs measurement adopted in this
thesis is based on the current evidence-based literature.
Part III: APACHE II score (Acute physiology and chronic
health evaluation II). The APACHE II is still commonly used as an
index of illness severity in critically ill patients admitted to ICU and has
been validated in many research and clinical audit purposes (Naqvi et al.,
2016) & (Lew et al., 2019). APACHE II is the severity of the disease
classification system. It uses a point score based upon values of 12
routine physiologic measurements taken either upon ICU admission or
within 24 h of entry. The score for each parameter was assigned from 0 to
4, with 0 being normal and four being the most abnormal. The sum of
these values was added to a mark adjusting for patient age and a mark
adjusting for chronic health problems (severe organ insufficiency or
immuno-compromised patients), to arrive at the APACHE II score. The
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values were scored in accordance with the APACHE II chart scoring for
abnormally high or low range. The zero scores represent a normal value.
Part IV: Mechanical ventilation parameter assessment sheet:
Mechanical ventilation parameter included mode of ventilation rate, tidal
volume, minute volume, a fraction of inspired oxygen, positive endexpiratory pressure, peak pressure, and pressure support.
Tool two: Acid-base parameters assessment:
The researcher developed this tool after reviewing the relevant
national and international literature to meet the need for the acid-base
evaluation proposed; it consists of two parts.
Part I: Arterial blood gases parameters assessment sheet: Acidbase parameters were calculated on arterial blood gases result. Analysis
of the ABG included pH values, the partial pressure of arterial carbon
dioxide (PaCO2), the partial pressure of the arterial oxygen (PaO2),
bicarbonate (HCO3), base excess (BEEcf), Oxygen Saturation (SaO2), and
lactate.
Part II: Laboratory investigations assessment sheet: Laboratory
variables needed for the acid-base evaluation proposed like Serum
electrolytes, including sodium (Na), potassium (K), magnesium (Mg2+),
calcium (Ca), kidney, and liver function tests, white blood cells,
Hemoglobin, hematocrit, and blood glucose (BG).
Part III: Signs and symptoms of acid-base imbalance
assessment sheet: The researcher developed this tool after reviewing the
relevant literature; to assess the signs and symptoms for types of acidbase disorders. Signs and symptoms of metabolic acidosis, metabolic
alkalosis, respiratory acidosis, and respiratory alkalosis.
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Tool three: Acid-Base Imbalances Risk factors assessment.
A risk factor assessment tool was specifically designed by the
researcher after reviewing the literature concerning risk factors of acidbase imbalance for critically ill patients in the intensive care unit Patients
were evaluated for risk factors of acid-base imbalance by using a risk
factor checklist sheet, where each factor was rated as ‘present’ or ‘absent’
depending on its presence or absence at the time of development of acidbase imbalance.
The main results:
Eighty patients suffered from acid-base disorders with mean age
(41.88 ±13.39) years. The mean pH on admission was (7.34 ±0.13); the
mean length of ICU stay was (10.90 ±7.86). The mean APACHE II score
on admission was (18.56 ± 6.89). Respiratory alkalosis was the most
frequent type of simple acid-base disorder (73.8%). Other simple acidbase disorders were relatively less frequent. Mixed acid-base disorders
were noted in a small number of patients; the common combination was
metabolic acidosis with respiratory acidosis (15.0%). The common risk
factors for metabolic acidosis were lactic acidosis, shock, and electrolyte
disorders (47.6%), respectively with the same percentage, while
gastrointestinal disorders were the most common risk factor for the
development of metabolic alkalosis (92.6%). Importantly respiratory
disorders represent the main risk factors for the development of
respiratory acidosis and respiratory alkalosis (96.2%) and (79.7%),
respectively. Cardiopulmonary arrest and hypovolemic shock represented
the main risk factors of mixed acidosis (50.0%), and (50.0%)
respectively.
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Conclusion:
Based on our findings of the current study, it can be concluded that
respiratory alkalosis was the most common among simple acid-base
disorders, whereas mixed acid-base disorders were the least frequently
observed patients. Critically ill patients are at risk for acid-base disorders
due to primary disease, chronic disease, presence of comorbidity, side
effects of some drugs used, or iatrogenic mechanical ventilation.
Therefore, recognizing the risk factors and any acid-base imbalance is
crucial to saving someone’s life.
Common risk factors for the development of metabolic acidosis
were observed in this study, including lactic acidosis, shock, and
electrolyte disturbances, which have the same percentage.
Gastrointestinal disorders such as frequent vomiting or prolonged
nasogastric aspiration for intestinal obstruction associated with loss of
gastric acid are the most potent risk factor for the development of
metabolic alkalosis.
Respiratory disorders were the most common risk factors of
respiratory acid-base disorders among critically ill patients.
Cardiopulmonary arrest and hypovolemic shock were the major risk
factors that predispose patients to develop mixed acidosis (metabolic
acidosis and respiratory acidosis