Positional hypoxemia during artificial ventilation

A comparative study of supine lying, side lying and prone positioning on oxygen saturation, in mechanically ventilated patients, in acute respiratory failure

“…But in ventilated patients temporary PO2 can rise if associated with the sigh with respective increase of end expiratory lung volume, which is often practiced in ICU. 31 In the present study statistical analysis shows additive benefit of side lying position over supine position. Thus it is confirmed that compared with supine position, side lying is more physiological and thus a more justifiable position in terms of its benefits.…”

“…Rivara studied 8 patients with unilateral interstitial pattern improvement in oxygenation which occurred when good lung was down is associated with changes in pattern of V/Q distribution, decrease in right to left intra pulmonary shunt. 31,32 When lung pathology is bilateral, arterial blood gases are improved, when patients lie on the right side compared with the left. 13 This can be explained by the greater size of the right lung and reduced compression of the height on lung in this position compared with left lying.…”

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

“…Our study predominantly recruited patients with unilobar, unilat- eral lung infiltrates (70%), whereas earlier studies commonly cite chest radiograph changes as involving both lobes but being predominantly unilateral. 14,15,26 This may explain why no effect was seen in the UniLP group between positioning with the bad lung up or bad lung down. Lateral positioning with the bad lung up is suggested to improve oxygenation through reductions in shunt or a reduction in areas of lung with low V/Q.…”

Physiotherapy in Intensive Care

“…Specific examples of positioning that may be used in the ICU setting include upright positioning to improve lung volumes and decrease the work of breathing in patients who are being weaned from mechanical ventilation; prone positioning to improve V /Q matching, redistribute edema, and increase functional residual capacity for patients with ARDS; side lying with the affected lung uppermost to improve V /Q matching for patients with unilateral lung disease; side lying with the affected lung uppermost to improve ventilation (via distending forces on the uppermost lung) and clearance of airway secretions for patients with acute lobar atelectasis. 5,[11][12][13][14][15][16][17][18][19][20][21][22]…”

“…Improvements in lung function have also been documented for patients with unilateral lung disease when they are positioned in side lying with the affected lung uppermost. [11][12][13][14] Ibanez et al 11 studied 10 patients (7 men, 3 women; mean age, 33.5 years) who were receiving mechanical ventilation because of acute respiratory failure and whose chest radiograph findings predominantly showed unilateral disease. They found that the Pao 2 /Fio 2 ratio significantly increased from 112 when patients were positioned in side lying with the affected lung dependent, to 189 when in side lying with the affected lung uppermost.…”