Seated and semi-recumbent positioning of the ventilated intensive care patient - effect on gas exchange, respiratory mechanics and hemodynamics

Thomas, Peter, Paratz, Jennifer and Lipman, Jeffrey (2014) Seated and semi-recumbent positioning of the ventilated intensive care patient - effect on gas exchange, respiratory mechanics and hemodynamics. Heart and Lung: Journal of Acute and Critical Care, 43 2: 105-111. doi:10.1016/j.hrtlng.2013.11.011


Author Thomas, Peter
Paratz, Jennifer
Lipman, Jeffrey
Title Seated and semi-recumbent positioning of the ventilated intensive care patient - effect on gas exchange, respiratory mechanics and hemodynamics
Journal name Heart and Lung: Journal of Acute and Critical Care   Check publisher's open access policy
ISSN 0147-9563
1527-3288
Publication date 2014-03-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.hrtlng.2013.11.011
Open Access Status Not yet assessed
Volume 43
Issue 2
Start page 105
End page 111
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Subject 2740 Pulmonary and Respiratory Medicine
2706 Critical Care and Intensive Care Medicine
2705 Cardiology and Cardiovascular Medicine
Abstract Objectives: To compare the effect of semi-recumbent and sitting positions on gas exchange, respiratory mechanics and hemodynamics in patients weaning from mechanical ventilation. Background: Upright positions are encouraged during rehabilitation of the critically ill but there effects have not been well described. Methods: A prospective, randomized, cross-over trial was conducted. Subjects were passively mobilized from supine into a seated position (out of bed) and from supine to a semi-recumbent position (>45° backrest elevation in bed). Arterial blood gas (PaO/FiO, PaO, SaO, PaCO and A-a gradient), respiratory mechanics (V V, RR, C, RR/V) and hemodynamic measurements (HR, MABP) were collected in supine and at 5min and 30min after re-positioning. Results: Thirty-four intubated and ventilated subjects were enrolled. The angle of backrest inclination in sitting (67±5°) was greater than gained with semi-recumbent positioning (50±5°, p<0.001). There were no clinically important changes in arterial blood gas, respiratory mechanic or hemodynamic values due to either position. Conclusions: Neither position resulted in significant changes in respiratory and hemodynamic parameters. Both positions can be applied safely in patients being weaned from ventilation.
Formatted abstract
Objectives: To compare the effect of semi-recumbent and sitting positions on gas exchange, respiratory mechanics and hemodynamics in patients weaning from mechanical ventilation.
Background: Upright positions are encouraged during rehabilitation of the critically ill but there effects have not been well described.
Methods: A prospective, randomized, cross-over trial was conducted. Subjects were passively mobilized from supine into a seated position (out of bed) and from supine to a semi-recumbent position (>45° backrest elevation in bed). Arterial blood gas (PaO2/FiO2, PaO2, SaO2, PaCO2 and A-a gradient), respiratory mechanics (VE, VT, RR, Cdyn, RR/VT) and hemodynamic measurements (HR, MABP) were collected in supine and at 5min and 30min after re-positioning.
Results: Thirty-four intubated and ventilated subjects were enrolled. The angle of backrest inclination in sitting (67±5°) was greater than gained with semi-recumbent positioning (50±5°, p<0.001). There were no clinically important changes in arterial blood gas, respiratory mechanic or hemodynamic values due to either position.
Conclusions: Neither position resulted in significant changes in respiratory and hemodynamic parameters. Both positions can be applied safely in patients being weaned from ventilation.
Keyword Intensive care
Posture
Respiratory mechanics
Semi-recumbent
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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