Body positioning and its effect on oxygenation – a literature review

Abstract

Evidence-based health care has become a priority in the National Health Service (NHS), with increased emphasis on clinical practices that are grounded in quality evidence rather than those that persist because of tradition. Turning and positioning of patients are well-accepted nursing activities. Appropriate positioning of the critically ill patient can dramatically improve gas exchange, resulting in a shorter stay in the critical care unit and an improved outcome. This study reviews the current published literature on the subject of positioning and gas exchange, with emphasis on oxygenation. Conclusions made from this study are that nurses need to be aware of how different positions can affect patients' oxygenation. Further research on exploring patients' experience of positioning within the critical care environment and nurses' understanding of positioning and oxygenation is needed.

Manual Turns in Patients Receiving Mechanical Ventilation

“…In 2 other systematic reviews that do not specifically address patients receiving mechanical ventilation, continuous lateral rotation therapy (CLRT) was compared with manual turning with a focus on ICU patients. 25,44 Similar inconclusive findings were reported and attributed to the problems with poor methodological reporting. 25,44 Thus, evidence regarding the degree of lateral tilts is such that a specific position cannot be recommended in terms of tilt or duration of tilt for decreasing complications of bed rest.…”

“…25,44 Similar inconclusive findings were reported and attributed to the problems with poor methodological reporting. 25,44 Thus, evidence regarding the degree of lateral tilts is such that a specific position cannot be recommended in terms of tilt or duration of tilt for decreasing complications of bed rest.…”

“…23 Among critically ill adults, lateral positions can impair oxygenation in patients with widespread unilateral infiltrates when the diseased lung is in the bottom position. 24,25 Physiological changes in vascular, lung, and intracranial measures have been reported and are thought to be a result of redistribution of venous volume or pressure immediately after lateral positioning, resolving within 5 to 10 minutes to baseline values. 23 …”

Mobilização terapêutica como cuidado de enfermagem: evidência surgida da prática

“…Ao associar o procedimento técnico em foco à finalidade para a qual, normalmente, ele é direcionado, verifica-se que seus benefícios não se restringem apenas à prevenção das úlceras por pressão, mas também, à prevenção da síndrome de desuso muscular (6)(7)(8) , ao conforto (9) , e à interferência no padrão respiratório com a otimização da relação ventilação/perfusão (10)(11)(12)(13)(14) do paciente.…”

“…Além disso, a mobilização adequada auxilia no processo do desmame da ventilação mecânica, proporcionando a melhora da relação ventilação/perfusão (V/Q) do tecido pulmonar, diminuindo a resistência ao trabalho muscular, e contribuindo assim para reduzir a sensação de dispnéia (8,(14)(15) . O decúbito pode influenciar na mecânica pulmonar, aumentando o trabalho respiratório e modificando a relação ventilação/perfusão dependendo da posição no leito e do grau de elevação do dorso (9)(10)(11)(12)(13)(14) . O conhecimento acerca da mudança de decú- bito e seus efeitos na oxigenação do paciente constituem saber essencial para enfermeiras que cuidam de pacientes em situação crítica (10) .…”