Head-of-bed elevation improves end-expiratory lung volumes in mechanically ventilated subjects: a prospective observational study

Spooner, Amy J., Corley, Amanda, Sharpe, Nicola A., Barnett, Adrian G., Caruana, Lawrence R., Hammond, Naomi E. and Fraser, John F. (2014) Head-of-bed elevation improves end-expiratory lung volumes in mechanically ventilated subjects: a prospective observational study. Respiratory Care, 59 10: 1583-1589. doi:10.4187/respcare.02733

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Author Spooner, Amy J.
Corley, Amanda
Sharpe, Nicola A.
Barnett, Adrian G.
Caruana, Lawrence R.
Hammond, Naomi E.
Fraser, John F.
Title Head-of-bed elevation improves end-expiratory lung volumes in mechanically ventilated subjects: a prospective observational study
Journal name Respiratory Care   Check publisher's open access policy
ISSN 0020-1324
1943-3654
Publication date 2014-10-01
Year available 2014
Sub-type Article (original research)
DOI 10.4187/respcare.02733
Volume 59
Issue 10
Start page 1583
End page 1589
Total pages 7
Place of publication Irving, TX United States
Publisher Daedalus Enterprises
Language eng
Formatted abstract
BACKGROUND: Head-of-bed elevation (HOBE) has been shown to assist in reducing respiratory complications associated with mechanical ventilation; however, there is minimal research describing changes in end-expiratory lung volume. This study aims to investigate changes in end-expiratory lung volume in a supine position and 2 levels of HOBE.

METHODS: Twenty postoperative cardiac surgery subjects were examined using electrical impedance tomography. End-expiratory lung impedance (EELI) was recorded as a surrogate measurement of end-expiratory lung volume in a supine position and at 20° and then 30°.

RESULTS: Significant increases in end-expiratory lung volume were seen at both 20° and 30° HOBE in all lung regions, except the anterior, with the largest changes from baseline (supine) seen at 30°. From baseline to 30° HOBE, global EELI increased by 1,327 impedance units (95% CI 1,080–1,573, P < .001). EELI increased by 1,007 units (95% CI 880–1,134, P < .001) in the left lung region and by 320 impedance units (95% CI 188–451, P < .001) in the right lung. Posterior increases of 1,544 impedance units (95% CI 1,405–1,682, P < .001) were also seen. EELI decreased anteriorly, with the largest decreases occurring at 30° (−335 impedance units, 95% CI −486 to −183, P < .001).

CONCLUSIONS: HOBE significantly increases global and regional end-expiratory lung volume; therefore, unless contraindicated, all mechanically ventilated patients should be positioned with HOBE.
Keyword End-expiratory lung volume
Electrical impedance tomography
Lung volume
Mechanical ventilation
Positioning
Surgery
Electrical impedance tomography
Cardiac output
Critically ill
Body position
Pneumonia
Therapy
Injury
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
School of Medicine Publications
 
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