Critical Review Based on PICOT

This critical review analyzes and summarizes three studies based on PICOT questions. The studies focus on the effectiveness of continuous positive airway pressure in patients with obstructive sleep apnea undergoing surgery. The findings suggest that continuous positive airway pressure is more effective in the preoperative period than in the postoperative period. The research has implications for nursing practice in managing patients with obstructive sleep apnea after surgery.

Running head: Critical Review Based on PICOT.
Critical Review Based on PICOT
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1Critical Review Based on PICOT
Qualitative and Quantities Studies
The main of the paper is to critically analyses and summarize the three studies. In the
paper, three articles are to be critiqued based on PICOT questions in which one is qualitative and
two quantitative studies. The article 1 is a qualitative study by Nagappa et al. (2015) where he
has studied “The Effects of Continuous Positive Airway Pressure on Postoperative
Outcomes in Obstructive Sleep Apnea Patients Undergoing Surgery”. Article 2 is
quantitative study by Chung et al. (2016) based on continuous positive airway pressure in
perioperative settings and article 3 is also quantitative study where the author has studies death
in patients with Obstructive Sleep Apnea which is a case report of critical complications.
The PICOT questions are used to critique the three article which includes backgrounds of the
study, ways by which these articles support the practice of nurse, method of studies, the result of
investigations, ethical consideration of each study, the comparison of outcome of each study.
The PICOT framework that was used for the development of the research question; what
is the effectiveness of the continuous positive airway pressure after the surgery of Obstructive
Sleep Apnea.
Background of Studies
In article 1, the clinical problem is prevalence of comorbid situation which is common in
patient of OBS. The condition is worsening the situation of patient and increase their long in say
in hospital. The study is significant to nursing practice because it evaluates the risk factor of the
condition which is common in a patient who have underwent surgical operation for OSA. It will
make nurse knowledgeable with the factor by which they can give appropriate intervention for
their care. The primary purpose of the study is to explore the efficiency of continuous positive

2Critical Review Based on PICOT
airway pressure as the mean of treatment and important element to lower the threat of
Obstructive Sleep Apnea. The research question of the study is what is the effect of CPAP in
OSA patients?
The article 2 the clinical problem describe is that there is a high chance of
cardiopulmonary complications in Obstructive Sleep Apnea patients. The study is significant to
nursing because it has outlined the risk factors associated with the Obstructive Sleep Apnea and
describe a method to tackle it. The primary purpose of the study is to find the way by which
Obstructive Sleep Apnea can be dealt with. The main objective is to study Continuous Positive
Airway Pressure as an effective treatment option for Obstructive Sleep Apnea. The research
question of the study is what the method by which Obstructive Sleep Apnea can be screened and
diagnosed is?
In article 3, the clinical problem is the high death rate which is happening because of
Obstructive Sleep Apnea. The research is important for the nurse because they will be able to
gather information regarding a way to reduce the incidence of death by Obstructive Sleep Apnea.
Chief purpose of the study is to examine the literature in order to identify the risk elements of
Obstructive Sleep Apnea complications and risk. The main objective of the article is to reduce
the death rate by health issue which is Obstructive Sleep Apnea and its problems. The research
question of the study is what are the potential effects and factors linked with the OSA.
The three of the study are related by the PICOT question as all the study have involved
particular methods and result with ethical boundaries. The studies focus on the Obstructive Sleep
Apnea and its ways of management, this links with the PICOT questions which seeks to evaluate
the risks of Obstructive Sleep Apnea in order to prevent it. The interventions being studies are

3Critical Review Based on PICOT
aligned with the PICOT questions and focus on answering what PICOT questions is tending to
find.
Method of Studies
In article 1, the method of the study is based on the systematic review of the article,
which has included adult surgical patients, pre/post-operative Continuous Positive Airway
Pressure. The primary strength of the study is that it has done a critical evaluation of the research
article and has used statistical analysis to conclude the result; therefore, the result is reliable. The
major limitation of the study is lack of diagrammatic representation of the study.
In article 2, the method of study used is a meta-analysis of the review of RCT article. The
data collected from the summary of article is based on Continuous Positive Airway Pressure
usage. The strength identified in the study is the comparative analysis, which has included nine
different studies and examined 904 patients. Thus the result is reliable. However, the study also
lacks any graphical representation of the result. The article 3 has done the analysis of the 15 case
reports, and medico-legal reports of the article searched online in the Medline database.
Statistical analysis is done to process the data extracted from the case study. The major strength
is the use of high sample size comprising of 60 patients and lacks in limited search of articles as
only Medline database is used.
The three studies are similar as all of them has done a review of article searched in an
online database. They differ in their analysis methods.
Result of Studies
The key finding of the result by Nagappa et al. (2015) is that there is no difference
noticed in post-operative situations of the patient before and after the Continuous Positive

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Airway Pressure treatment. Continuous Positive Airway Pressure treatment is active mostly
during the perioperative period.
The study by Chung et al. (2016) has found that Continuous Positive Airway Pressure given is
effective in preoperative events as it helps to reduce co-morbid conditions and does not show any
effect in the postoperative period.
The study by Subramani et al. (2017) has found that risk factors for the complication of
Obstructive Sleep Apnea which are obesity, undiagnosed Obstructive Sleep Apnea, opioids, male
sex, lack of observations and sedatives. The author concluded by saying that Continuous Positive
Airway Pressure is efficient in the preoperative event to reduce the identified risk factors.
The result of the study poses an implication for future research. As all the research has
identified the same effect, it calls for more research on Continuous Positive Airway Pressure
given after surgery to the patient of Obstructive Sleep Apnea. For nursing practice, they can
include Continuous Positive Airway Pressure before the operation in Obstructive Sleep Apnea
condition and should work to find its effectiveness after the surgery.
Ethical Consideration
The ethical considerations that must be taken while conducting any kind of research are:
Ethical approval – To conduct any kind of research, it is of prime significance to seek
approval from the research committee in order to protect from any kind of risk and self-harm
because of the research. If consent is not taken, the research committee can reject the project and
does not give an allowance to get published (Roberts, 2015).
Publishing ethics- For the type of studies which has involved the review of the articles
must follow the ethics of not manipulating the data, must be plagiarism free and should not

5Critical Review Based on PICOT
duplicate the publication. Maintenance of such ethic help is approval of the study (Gorman-
Murray, Johnston & Waitt, 2016).
The three of the study has incorporated the above-stated ethics in order to conduct the
research. The studies have taken approval from the research committee before initiating the
research and have not manipulated any of the data used and analysis. The article was taken also
has plagiarism free, and no duplication of study has been done in the research. Apart from this
there is not information regarding the conflict of interest in all the three studies.
Outcomes Comparison
The critical underlining outcome of the PICOT questions is that there is the effectiveness
of continuous positive airway pressure in a patient undergoing sleep apnea operation both post-
operative and pre-operative. Continuous Positive Airway Pressure is regarded as the way of
management of patients after the surgery. From the critical analysis of the three studies, it is
found that continuous positive airway pressure is more productive during the pre-operative
events and does not show any significant changes and positive effects during the post-operative
event. Therefore, on comparing the anticipated result of the PICOT questions and outcome of the
result, the difference in both result has been noted. It was thought that Continuous Positive
Airway Pressure is effective in both pre/post-operative event, however, it is beneficial only
during pre-operative event in Obstructive Sleep Apnea patients.
Conclusion
Lastly, from the above critical analysis, it can be concluded by saying that Obstructive
Sleep Apnea is a sleep syndrome whose commonness is cumulating at an alarming rate.
Continuous positive airway pressure therapy is beneficial during the pre-operative adverse event.

6Critical Review Based on PICOT
However, in post-operative adverse events such as Apnea-hypopnea index in hospital remains
unaffected. There has been advance in surgical care, but still, it is continuing a severe problem
for the management of Obstructive Sleep Apnea in patients. There is a great need for the
intensive research which can find the Continuous Positive Airway Pressure positive effects in the
Obstructive Sleep Apnea patients. The research is effective as it will make an implication to
nursing practice. The nurse will be able to manage the patient after the surgery of Obstructive
Sleep Apnea.

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Reference
Chung, F., Nagappa, M., Singh, M., &Mokhlesi, B. (2016). CPAP in the perioperative setting:
evidence of support. Chest, 149(2), 586-597. Retrieved from
https://doi.org/10.1378/chest.15-1777
Gorman-Murray, A., Johnston, L., & Waitt, G. (2016). Queer (ing) Communication in Research
Relationships: A Conversation about Subjectivities, Methodologies and Ethics 1.
In Queer Methods and Methodologies (Open Access) (pp. 97-112). Routledge.
https://www.taylorfrancis.com/books/e/9781315603223/chapters/10.4324/978131560322
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Nagappa, M., Mokhlesi, B., Wong, J., Wong, D. T., Kaw, R., & Chung, F. (2015). The effects of
continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea
patients undergoing surgery: a systematic review and meta-analysis. Anesthesia &
Analgesia, 120(5), 1013-1023. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/25899270
Roberts, L. D. (2015). Ethical issues in conducting qualitative research in online
communities. Qualitative Research in Psychology, 12(3), 314-325.
https://doi.org/10.1080/14780887.2015.1008909
Subramani, Y., Nagappa, M., Wong, J., Patra, J., & Chung, F. (2017). Death or near-death in
patients with obstructive sleep apnoea: a compendium of case reports of critical
complications. BJA: British Journal of Anaesthesia, 119(5), 885-899. Retrieved from
https://bjanaesthesia.org/article/S0007-0912(17)53901-X/pdf