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

Thomas, Peter J.; Paratz, Jennifer; Lipman, Jeffrey; Stanton, Warren R.

doi:10.1016/j.hrtlng.2006.10.008

Cited by 40 publications

(33 citation statements)

References 33 publications

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“…When the relationship between different body positions, PaCO 2 response, and respiratory mechanics is considered, Thomas et al [18] found that lateral positioning had no effect on PaO 2 /FiO 2 in ventilated intensive care patients. An-other study observed that body positioning had no effect on respiratory patterns and dynamics during NPPV therapy in patients with stable COPD.…”

Section: Discussionmentioning

confidence: 99%

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Türk¹,

Aydoğdu²,

Gürsel³

2018

Turk Thorac J

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OBJECTIVES:Different outcomes and success rates of non-invasive positive pressure ventilation (NPPV) in patients with acute hypercapnic respiratory failure (AHRF) still pose a significant problem in intensive care units. Previous studies investigating different modes, body positioning, and obesity-associated hypoventilation in patients with chronic respiratory failure showed that these factors may affect ventilator mechanics to achieve a better minute ventilation. This study tried to compare pressure support (BiPAP-S) and average volume targeted pressure support (AVAPS-S) modes in patients with acute or acute-on-chronic hypercapnic respiratory failure. In addition, short-term effects of body position and obesity within both modes were analyzed. MATERIAL and METHODS:We conducted a randomized controlled study in a 7-bed intensive care unit. The course of blood gas analysis and differences in ventilation variables were compared between BiPAP-S (n=33) and AVAPS-S (n=29), and between semi-recumbent and lateral positions in both modes. RESULTS:No difference was found in the length of hospital stay and the course of PaCO2, pH, and HCO3 levels between the modes. There was a mean reduction of 5.7±4.1 mmHg in the PaCO2 levels in the AVAPS-S mode, and 2.7±2.3 mmHg in the BiPAP-S mode per session (p<0.05). Obesity didn't have any effect on the course of PaCO2 in both the modes. Body positioning had no notable effect in both modes. CONCLUSION:Although the decrease in the PaCO2 levels in the AVAPS-S mode per session was remarkably high, the course was similar in both modes. Furthermore, obesity and body positioning had no prominent effect on the PaCO2 response and ventilator mechanics. Post hoc power analysis showed that the sample size was not adequate to detect a significant difference between the modes.

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Section: Discussionmentioning

confidence: 99%

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Türk¹,

Aydoğdu²,

Gürsel³

2018

Turk Thorac J

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“…Forty-five degrees was selected as the cut point on the basis of the median angle reported in previous studies of lateral positioning. 22 The presence of the following potential contraindications for semirecumbent positioning at 45º from the horizontal were observed: suspected or existing spinal injury; intracranial hypertension; hemodynamic instability; unstable pelvic fracture; prone positioning; hemodynamic support devices such as an intra-aortic balloon pump, left ventricular assist device, and extracorporeal membrane oxygenation; femoral catheterization for continuous renal replacement therapy; abdominal wound; after femoral sheath removal; and a procedure underway.…”

Section: About the Authorsmentioning

confidence: 99%

Semirecumbent Positioning in Ventilator-Dependent Patients: A Multicenter, Observational Study

Rose¹,

Baldwin²,

Crawford³

et al. 2010

American Journal of Critical Care

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Background Positioning of patients is a modifiable risk factor for ventilator-associated pneumonia. Current guidelines for prevention of ventilator-associated pneumonia recommend semirecumbency at 30º, with 45º preferable unless contraindicated. Objective To assess the use of semirecumbency for ventilator patients in Australian and New Zealand intensive care units. Methods In a multicenter, observational study, backrest elevation, mean arterial pressure, use of inotropic agents, enteral feeding, and weaning status were recorded 3 times per day by using a predetermined randomization schedule for 7 consecutive days (maximum 21 observation episodes). Severity of illness was recorded daily by using the Sepsis-Related Organ Failure Assessment (SOFA) score. Results Measurements (n = 2112) were recorded for 371 ventilator patients in 32 intensive care units. Backrest elevation at ≥45º was noted for 112 of 2112 (5.3%; 95% confidence interval [CI], 4.3-6.3) measurements; elevation ≥30º but <45º for 472 of 2112 (22.3%; 95% CI, 20.6-24.1). Contraindications to semirecumbency were noted during 447 measurements. Increased backrest elevation occurred during enteral feeding (2.2º, P < .001) and weaning (3.1º, P < .001). Decreased backrest elevation was associated with inotropic support (2.8º, P < .001), decreased mean arterial pressure (0.7º/10 mm Hg, P < .001), and organ failure (0.5º/1-point increment in SOFA max score, P < .001). For measurements recorded with no contraindication to semirecumbency, weaning status (P = .003) and SOFA max score (P = .008) remained associated with the degree of backrest elevation. Conclusions The findings of this multicenter, observational study suggest that backrest elevation was less than recommended and was influenced by clinical practices and patient condition.

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“…While studies [10][11][12] investigating the effects of lateral position in patients with bilateral lung infiltrates reported insignificant changes in oxygenation, PaO 2 values in supine position were not always between those in the two lateral positions. [4] Although asymmetry of the two-lung disease is not clear in these studies, we too did not Þ nd signiÞ cant changes in oxygenation in patients of bilateral lung inÞ ltrates till the LIS difference in the two lungs reached ≥3.…”

Section: Discussionmentioning

confidence: 86%

“…[8] Although radiographically and by deÞ nition, ARDS is a bilateral lung disease, blood oxygenation (PaO 2 ) in 5 of the 6 studied patients differed during lateral positioning, suggesting asymmetric lung involvement. [9] Since variable effects on oxygenation during lateral positioning of patients have been reported, [4,[10][11][12][13] the effects of lateral positioning of ARDS patients are unclear. After extensive literature search, we did not find a method to quantify or predict the asymmetry of the lung disease.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore

et al. 2009

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

Cited by 40 publications

References 33 publications

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Semirecumbent Positioning in Ventilator-Dependent Patients: A Multicenter, Observational Study

Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore

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