Lateral positioning of ventilated intensive care patients: A study of oxygenation, respiratory mechanics, hemodynamics, and adverse events

Thomas, Peter J., Paratz, Jennifer D., Lipman, Jeffrey and Stanton, Warren R. (2007) Lateral positioning of ventilated intensive care patients: A study of oxygenation, respiratory mechanics, hemodynamics, and adverse events. Heart & Lung, 36 4: 277-286. doi:10.1016/j.hrtlng.2006.10.008


Author Thomas, Peter J.
Paratz, Jennifer D.
Lipman, Jeffrey
Stanton, Warren R.
Title Lateral positioning of ventilated intensive care patients: A study of oxygenation, respiratory mechanics, hemodynamics, and adverse events
Journal name Heart & Lung   Check publisher's open access policy
ISSN 0147-9563
Publication date 2007-07
Sub-type Article (original research)
DOI 10.1016/j.hrtlng.2006.10.008
Volume 36
Issue 4
Start page 277
End page 286
Total pages 10
Place of publication New York
Publisher Mosby, Inc.
Collection year 2008
Language eng
Subject 11 Medical and Health Sciences
1102 Cardiovascular Medicine and Haematology
1110 Nursing
Formatted abstract
Objectives

To investigate the effect of 90° lateral positioning on oxygenation, respiratory mechanics, and hemodynamics in ventilated intensive care patients.

Methods


Thirty-four subjects (mean age = 46.1 ± 17.3 years) with no, unilateral, or bilateral pulmonary infiltrates on chest radiograph participated. Arterial blood gas, respiratory mechanic, and hemodynamic data were analyzed at the supine starting position (T0), then 30 minutes and 2 hours into the lateral turn (T30 and T120, respectively) and 30 minutes post return to the supine position (T150).

Results


No difference was found in PaO2/FiO2 due to positioning patients from supine to lateral (P = .15) regardless of the underlying lung pathology. Dynamic compliance decreased during lateral positioning, particularly in the subjects with no lung pathology (T0 = 56 ± 18.6 > (T30 = 49.9 ± 18; T120 = 49.2 ± 17) L/cmH20, P < .01) or unilateral lung pathology (T0 = 41.4 ± 11.2 > (T30 = 36.6 ± 8.8; T120 = 37.3 ± 9.5) L/cmH20, P < .01). Blood pressure and heart rate were unaffected, but cardiac index significantly increased at T30 (T0 = 3.7 ± 1.2, T30 = 4.8 ± 1.3 L/min/m2, P < .01). While the incidence of adverse events was high (21%), they were primarily minor and transient.

Conclusions


In this heterogeneous population, lateral positioning had no beneficial effect on gas exchange. However, in ventilated patients who were hemodynamically stable, it was well tolerated and not associated with significant serious adverse events.

Keyword Cardiac & Cardiovascular Systems
Nursing
Respiratory System
Critically-ill Patients
Clinical-practice
Distress-syndrome
Randomized-trial
Body Position
Pneumonia
Disease
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Mon, 18 Feb 2008, 14:29:11 EST