Investigation into the effect of family presence in intensive care unit during awakening process after coronary artery by-pass grafting surgery on surgical stress response

In the awakening process after CABG surgery, patients experience fear and security concerns due to reasons such as separation from family, being in a foreign environment. This situation contributes to the increase of the surgical stress response. It was aimed to investigate the effect of an informed and prepared family member's presence in the awakening process in ICU on patients' level of anxiety, surgical stress response, serum cortisol, insulin and glucose after CABG surgery. It was a nonrandomized controlled clinical study performed in the cardiovascular surgery clinic of Gaziantep Medical Park Hospital between January-July 2018. The study was conducted with 73 patients including 36 for Intervention Group (IG) and 37 for Control Group (CG) who met the sampling criteria and volunteered to participate in the study. Data was first collected for CG, then for IG patients. There was no intervention within the scope of the research for the patients in CG, and routine treatment and care practices were continued in the intensive care unit. In addition to routine treatment and care practices of the patients in IG in intensive care unit, an Informed Family Member (IFM) they chose was taken into intensive care during the awakening process. Blood samples were taken from the patients in both groups at 09:00 in the morning before the surgery (T0), six hours after extubation on the surgery day (T1) and at 09:00 in the morning of the day after the surgery (T2) to determine serum cortisol, insulin and glucose levels. Vital signs were measured, pain was evaluated with Visual Analog Scala (VAS) and State Trait Anxiety Inventory (STAI) was used in evaluation of anxiety. Serum cortisol, insulin and glucose levels was found out by the method of Enzyme Linked Immunosorbent Assay (ELISA). Statistical analysis was performed in SPSS for Windows 21.0 package program. A p value of <0.05 was accepted for statistical significance. Patients in the intervention and control groups were similar in terms of their characteristics (p> 0.05). The difference between serum cortisol levels measured in T0 and state anxiety scores of patients in both groups was not statistically significant (p> 0.05). Serum cortisol measured in T1 and state anxiety scores were lower in the IG than in CG (p <0.05). The amount of midazolam and propofol used in intensive care unit was lower in IG than that of CG (p <0.05). Intubation, sedation and duration of staying in intensive care unit were shorter in IG than that of CG (p <0.05). The presence of IFM during awakening process in the intensive care unit after CABG surgery was found to be effective in decreasing serum cortisol level, state anxiety, sedative drug requirement, intubation, sedation and intensive care unit stay. It was concluded that the presence of IFM in the ICU may contribute to the recovery of patients by reducing SSR after CABG surgery. Keywords: Anxiety, Coronary Artery By-Pass Surgery, Family, Intensive Care Unit, Nursing, Serum Cortisol Level, Surgical Stress Response