الفهرس 
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Abstract
When respiratory system cannot provide adequate oxygen needed for metabolic demand, respiratory failure occurs due to lung diseases such as acute respiratory distress and pneumonia. Respiratory failure requires mechanical ventilation to improve gas exchange. Mechanical ventilation weaning involves gradually reducing respiratory support and giving children spontaneous breathing time to manage gas exchange. Extubation means endotracheal tube removal, where ventilated children maintain an efficient gas exchange without ventilatory support or with limited help. Extubation success and failure depend on airway protection, secretion management, and upper respiratory tract patency. If extubation fails, the children will then need reventilation. Therefore, after mechanical ventilation extubation, to prevent reventilation, children must receive a range of nursing care as post extubation“.
This study aimed to find out the relationship between nursing care provided for children post-extubated from mechanical ventilation and their reventilation.
A convenient sample of 50 post extubated children and all nurses provided care to these children constituted the sample. Three tools were used to collect the necessary data. Tool I: characteristics of children and their medical data assessment sheet. Tool II: Nursing care provided for children post-extubated from mechanical ventilation observational checklist. Tool III: Reventilation assessment sheet. characteristics of nurses were attached to tool II.
The main results of the study were:
- “Children aged less than one year constituted 70% of the subjects with a mean age 10.41+11.13 months.
- Slightly more than half of the children were females (54%).
- Respiratory failure was the cause of mechanical ventilation for 76% of the children.
- Slightly less than half of the nurses aged less 30 years with a mean age of 31.76+6.69 years.
- Sixty four percent of nurses have a bachelor’s degree in nursing.
- Slightly less than half of nurses had less than 5years of experience (48%).
- Only 10% of nurses attended the training workshop about MV.
- Only 14% of the extubation children were reventilation.
- Apnea was the cause of reventilation for 57.1% of children, low oxygen saturation was the cause for 42.9 % of children.
- All the nurses followed the right step of measuring temperature for reventilated and not-reventilated children (almost most of steps were done in 100% of observations).
- All nurses either in not-reventilated and reventilated children followed the right steps of measuring apical pulse except during 1.6% of observations of not-reventilated children didn’t place stethoscope between the 2nd&3rd for infant and between 4th&5th intercostal space.
- In measuring peripheral pulse, nurses followed the right steps in only 30.2% and 28.6% of the observations for not- reventilated and reventilation children respectively especially in counting the peripheral pulse in 60 minutes.
- Respiration was counted in 97.7% of the observations for not-reventilated and during all the observations for reventilated children (100%).
- All nurses followed the right steps of measuring electronic blood pressure for reventilated children (100% of each step-in observation) and between 100% and 96.9% of observations of not-reventilated children.
- In measuring mercury blood pressure, it was measured except for not-reventilated children, where nurses followed the right steps in 80% of the observations.
- Oxygen saturation was measured properly by pulse oximeter except recording it as recorded in 83.7% of the observations of not- reventilated children compared to 71.4% for reventilated children.
- In changing children’s position to supine position, all nurses followed the steps (100% of the observations) except adding rolls under legs to encourage flexion as it was done in 88.4% and 85,7% of observations of not-reventilated and reventilated children respectively.
- Changing children’s position to semi-prone position, it was done in 65.1% of not-reventilated children compared to 38.1% of reventilated children and the difference was statistically significant (P=0.0.16).
- None of the nurses changed the children’s position to prone for both not-reventilated and reventilated children (0.0% for each group).
- All nurses changed children’s position every 2 hours either for not-reventilated or reventilated children (100% of observations for each).
- All nurses followed the right step of gavage feeding for reventilated children (100% of observations for each step), while majority of nurses performed almost all the steps for not-reventilated children (percentage ranged between 100% to 98.9% of observations).
- Means of gavage feeding of not-reventilated children was 18.50±0.907 and 19.00±0.000 for reventilated ones and but the difference was not statistically significant.
- Steps of bottle feeding were followed in 100% of observations for each step.
- The majority of nurses performed almost all steps of bottle feeding for not- reventilated children (the percentage ranged between 100% to 94.9% of the observations).
- Almost all nurses’ practices of oropharyngeal care were right for not-reventilated children as it ranges between 100% and 89.1% of observations and between 100% 71.4% for reventilated children.
- Introducing suction to oral cavity without applying suction was followed in 93.0% of not-reventilated children compared to 71.4% of reventilated ones.
- In postural drainage, nurses followed all the steps in postural pre-steps and middle or – low lobes in the observations of both not-reventilated and reventilated children (100% for each step).
- In posterior lower lobes of postural drainage, steps were followed between 58.9% to 2.3% of observations for not-reventilated children and between 12% to 0.0% of observations for reventilated children.
- Only in 4.7% and 2.3% of observations of not-reventilated and none of reventilated children, nurses either kept bed flat or placed children in prone position.
- Percussion in postural drainage was carried out in all the observations of not-reventilated children and during 85-7% of observations of reventilated children.
- In vibration of postural drainage, it was done in three fourth of observations of not-reventilated (67.4% for each step) compared to 28.6% of reventilated children’s observations and the difference was statistically significant (P=0.001).
- Nurses’ practices were satisfactory in 93.3% of observations of not-reventilated compared to 57.1% of reventilated children.
- Total means of care were 105.17±6.901 and 98.48±686 of not-reventilated and reventilated children respectively and the difference was statistically significant (P=0.000).
- There were relationships between nurses’ level of extrapulmonary and pulmonary care and the reventilation of the children in changing children’s position to semi- prone position (P= 0.018).
- There was statical significant differences in postural drainage, especially in percussion and vibrations of the children (P = 0.000 and P = 0.001 for percussion and vibration respectively), where they were done for not-reventilated more than the reventilated ones.
- No significant difference was found between nurses’ level of care and their characteristics.
- There were statistically significant differences between mean score of not-reventilated and reventilated children in total extrapulmonary care(P = 0.010), mercury temperature measurement (P = 0.017), change position to semi-prone position (P = 0.016), bottle feeding (P = 0.018), and percussion of ventilated (P = 0.00) and vibration (P = 0.001) respectively.
- No relationship between nurses’ level of care and their characteristics, where the P ranged between P=0.643 for years of experience and P=0.487 for attending previous training on mechanical ventilation“.