Immobility, Hypoxemia, and Pulmonary Arteriovenous Shunting

Ray, Jefferson F.; Yost, Leon; Moallem, Sha; Sanoudos, George M.; Villamena, Patricia; Paredes, R; Clauss, Roy H.

doi:10.1097/00132586-197508000-00054

Cited by 5 publications

(6 citation statements)

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“…(48) MV patients have increased bronchial secretion retention risks that are related to the functional impact of the underlying disease or the therapeutic intervention, either alone or in combination. These issues include tracheal intubation, which is related to impairment of the mucociliary system, (49)(50)(51) rheological changes of mucus; (52) immobilization due to being restricted to bed; (51)(52)(53) overall weakness leading to ineffective coughing; (54) and fluid restriction that may contribute to increased mucus viscosity. (55) Bronchial hygiene therapy (BHT) is a set of interventions to promote or support the removal of a patient's airway secretions.…”

Section: Pulmonary Expansion Therapymentioning

confidence: 99%

“…Measures are recommended that increase inspiratory volume in patients with an inability to generate appropriate pulmonary expansion for effective coughing, (48,51,57) as are measures that promote increased expiratory flow related to expiratory muscle dysfunction. (48,51,54,56,57) Oscillations should be used to increase airflow and mucus interaction, which modifies secretion viscosity by changing intra-thoracic pressures. (58)(59)(60)(61) Resources promoting increased RFC are recommended for air trapping prevention and therapy, early airway closure prevention, atelectasis prevention and therapy, and optimization of bronchodilators during BHT.…”

Section: Pulmonary Expansion Therapymentioning

confidence: 99%

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Fisioterapia em pacientes críticos adultos: recomendações do Departamento de Fisioterapia da Associação de Medicina Intensiva Brasileira

França¹,

Ferrari²,

Fernandes³

et al. 2012

Rev. bras. ter. intensiva

122

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Complications from immobility in intensive care unit patients contribute to functional decline, increased healthcare costs, reduced quality of life and higher post-discharge mortality. Physical therapy focuses on promoting recovery and preserving function, and it may minimize the impact of these complications. A group of Brazilian Association of Intensive Care Medicine physical therapy experts developed this document that contains minimal physical therapy recommendations appropriate to the Brazilian real-world clinical situation. Prevention and treatment of atelectasis, procedures related to the removal of secretions and treatment of conditions related to physical deconditioning and functional decline are discussed. Equally important is the consideration that prescribing and executing activities, mobilizations and exercises are roles of the physical therapist, whose diagnosis should precede any intervention.

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Section: Pulmonary Expansion Therapymentioning

confidence: 99%

Section: Pulmonary Expansion Therapymentioning

confidence: 99%

Fisioterapia em pacientes críticos adultos: recomendações do Departamento de Fisioterapia da Associação de Medicina Intensiva Brasileira

França¹,

Ferrari²,

Fernandes³

et al. 2012

Rev. bras. ter. intensiva

122

View full text Add to dashboard Cite

show abstract

“…The complications of bed rest have been known for nearly a century [ 1 ]. Routine care of mechanically ventilated patients typically involves a regimen of body position changes to aid in the prevention of skin breakdown, to enhance secretion clearance, and to improve ventilation/ perfusion relationships [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury

et al. 2001

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Background:Routine turning of critically ill patients is a standard of care. In recent years, specialized beds that provide automated turning have been introduced. These beds have been reported to improve lung function, reduce hospital-acquired pneumonia, and facilitate secretion removal. This trial was designed to measure the physiological effects of routine turning and respiratory therapy in comparison with continuous lateral rotation (CLR).Methods:The study was a prospective, quasi-experimental, random assignment, trial with patients serving as their own controls. Paralyzed, sedated patients with acute respiratory distress syndrome were eligible for study. Patients were randomized to receive four turning and secretion management regimens in random sequence for 6 h each over a period of 24 h: (1) routine turning every 2 h from the left to right lateral position; (2) routine turning every 2 h from the left to right lateral position including a 15-min period of manual percussion and postural drainage (P&PD); (3) CLR with a specialized bed that turned patients from left to right lateral position, pausing at each position for 2 min; and (4) CLR with a specialized bed that turned patients from left to right lateral position pausing at each position for 2 min, and a 15-min period of percussion provided by the pneumatic cushions of the bed every 2 h.Results:Nineteen patients were entered into the study. There were no statistically significant differences in the measured cardiorespiratory variables. There was a tendency for the ratio of partial pressure of arterial oxygen to fractional inspired oxygen concentration (PaO2/FIO2) to increase (174 ± 31 versus 188 ± 36; P = 0.068) and for the ratio of deadspace to tidal volume (Vd/Vt) to decrease (0.62 ± 0.18 versus 0.59 ± 0.18; P = 0.19) during periods of CLR, but these differences did not achieve statistical significance. There were statistically significant increases in sputum volume during the periods of CLR. The addition of P&PD did not increase sputum volume for the group as a whole. However, in the four patients producing more than 40 ml of sputum per day, P&PD increased sputum volume significantly. The number of patient turns increased from one every 2 h to one every 10 min during CLR.Conclusion:The acute effects of CLR are undoubtedly different in other patient populations (spinal cord injury and unilateral lung injury). The link between acute physiological changes and improved outcomes associated with CLR remain to be determined.

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“…In addition to this loss of dependent lung volume with anaesthesia, there is circumferential compression of the dependent lung by the mediastinum, abdominal contents and surgical manoeuvres [9]. Secretions may accumulate and there may be transudation of fluid in the dependent lung (which may be vertically below the left atrium), leading to airway closure [25]. Pulmonary vascular resistance in the dependent lung determines the ability of the ventilated lung to accept redistributed blood flow from the hypoxic lung.…”

Section: Discussionmentioning

confidence: 99%

Variation in the arterial to end-tidal P co 2 difference during one-lung thoracic anaesthesia † †An abstract of this work was presented to the Anaesthesia Research Society Meeting in Newcastle on April 3 1993 (British Journal of Anaesthesia 1993; 71: 316P).

Yam

Innes

Jackson

et al. 1994

British Journal of Anaesthesia

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We have measured the arterial to end-tidal PCO2 difference (PaCO2-PE'CO2) in 22 patients undergoing pulmonary resection in the lateral thoracotomy position during two-lung ventilation (TLV) and after transition to one-lung ventilation (OLV). With OLV for each patient, the practice of correcting the estimate by an initial measurement of (PaCO2-PE'CO2) was evaluated by subtracting the initial (PaCO2-PE'CO2) from subsequent values measured at 10-min intervals. Net (uncorrected) and corrected differences during OLV were analysed using ANOVA. (PaCO2-PE'CO2) values during TLV and OLV were similar: mean (SD) 1.3 (0.6) kPa and 1.2 (0.7) kPa, respectively (ns). Mean (PaCO2-PE'CO2) varied in the range 0.2-2.5 kPa, while maximum (PaCO2-PE'CO2) was 0.3-2.8 kPa. The mean (SD) of 133 pairs of measurements with OLV was 1.1 (0.7) kPa. Even after correction, mean (PaCO2-PE'CO2) varied in the range -0.7 to 0.8 kPa; individual extreme values were from -1.3 to 1.7 kPa. Variation between patients was found to be greater than variation within patients for both net and corrected differences (F ratio = 37.0 and 10.9, respectively), although calculating a corrected difference did reduce variation between patients from a mean square value of 2.44 to 0.61. The wide variation in (PaCO2-PE'CO2) suggests that the accuracy of estimation of PaCO2 by monitoring PE'CO2, although improved by the use of a corrected difference, remains questionable during OLV.

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Immobility, Hypoxemia, and Pulmonary Arteriovenous Shunting

Cited by 5 publications

References 0 publications

Fisioterapia em pacientes críticos adultos: recomendações do Departamento de Fisioterapia da Associação de Medicina Intensiva Brasileira

Fisioterapia em pacientes críticos adultos: recomendações do Departamento de Fisioterapia da Associação de Medicina Intensiva Brasileira

The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury

Variation in the arterial to end-tidal P co 2 difference during one-lung thoracic anaesthesia † †An abstract of this work was presented to the Anaesthesia Research Society Meeting in Newcastle on April 3 1993 (British Journal of Anaesthesia 1993; 71: 316P).

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