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

Authors

  • Prajakta S. Patil Smt Kashibai Navale College of PT, Narhe, Pune
  • Raziya Nagarwala Sancheti Institute College of PT, Pune Maharashtra

DOI:

https://doi.org/10.18203/2320-6012.ijrms20150241

Keywords:

Acute respiratory failure, Atelectasis, Oxygen saturation, ARDS

Abstract

Background: Body positioning refers to optimize O2 transport by manipulating effect of gravity on cardiopulmonary and cardiovascular function. Positioning should be an integral part of respiratory care, especially when prophylaxis is aim. Turning patient supine to lateral to prone to lateral, at least hourly makes a difference between living and dying for intensive care patient. Positioning reduces atelectasis and improves gas exchange.

Methods: Total 33 subjects aged between 15-73 years, 21 male and 12 female patients were selected for study from ICU, Neurological trauma unit Pune. Inclusion criteria: All subjects with respiratory failure due to different pathologies like ARDS, Pulmonary edema, pneumonia, tuberculosis, collection of fluid in pleural cavity with underlying lung collapse. Exclusion criteria: Unstable cardiac conditions, unstable fractures, unstable hemodynamic, recently operated cardiac subjects. The patients were kept in supine position, lateral and prone and vitals like BP, HR, RR and oxygen saturation with help of pulse oximeter noted just before position. Thorough ET or tracheostomy suction was done. Before turning patient if any intercostal drain present was clamped.

Results: Paired t-test was used. p values for prone and bilateral side lying positions was < 0.05 showing its significance for above mentioned 3-positions. p value for supine was not < 0.05 showing its non-significance.

Conclusion: The study concluded that oxygen saturation improves in prone lying and side lying position as compared to supine lying. But this improvement is quiet significant in prone position as compared to side lying.

 

References

Antunes LC, Rugolo LM, Crocci AJ. Effects of preterm infant position on weaning from mechanical ventilation. 2003;79(3):239-44.

Alexandra Hough in Physiotherapy in respiratory care.second edition; 110-112.

Berney S, Haines K, Denehy L. Physiotherapy in Critical Care in Australia. Cardiopulm Phys Ther J. 2012;23(1):19–25.

Pathmanathan N, Beaumont N, Gratrix A. Respiratory Physiotherapy in the critical care unit. Contin Educ Anarsth Crit Care Pain. 2014;27.

Melo MFD, Musch G, Kaczka DW. Pulmonary pathophysiology and lung mechanics in Anaesthesiology: A case based overview. Anesthesio Clin. 2012;30(4):759-84.

Whitehead T, Slutsky AS. The pulmonary physician in critical care 7. Ventilator induced lung injury. Thorax. 2002;57:635–42.

Ibanez J, Raurich JM, Abizanda R, Claramont R,Ibaneze P, Bergada J. The effects of lateral positions on gas exchange in patients with unilateral lung disease during mechanical ventilation. Intensive care med. 1981;7(5):231-4.

Elizabeth Dean. Effect of Body Position on Pulmonary Function. 1985;65(5).

Pelosi P, D’Amato G, Liccardi G, D’Amato M, Cazzola M. Prone position in acute respiratory distress syndrome. European Respiratory J. 2002;20(4):1017-28.

Petersson J, Sa´nchez-Crespo A, Larsson SA, Mure M. Paradoxical redistribution of pulmonary blood flow in prone and supine humans exposed to hypergravity. J Appl Physiol. 2006;100:240–8.

Lamm WJ, Starr IR, Neradilek B, Polissar NL, Glenny RW, Hlastala MP. Mechanism by which the prone position improves oxygenation in acute lung injury. Am J Respir Crit care med. 1994;150:184-93.

Pryor J, bWeber BA. Physiotherapy for respiratory and cardiac problem. Second edition; 275.

Donna Frownfelter D, Dean E. Principles and practices of cardiopulmonary physical therapy; 738-741.

Kraits JW. Respiratory failure and mechanical ventilation. 2005.

Andrew. Criticare book. ICU2003.

Dr A Chaudhary, Consie. Medical Physiology book.

Guyton AC, Hall J, Medical Physiology book. Tenth edition; 474.

Mure M, Martling CR, Lindahi SGE. Dramatic effect on oxygenation in patients with severe acute lung insuffiency treated in the prone position. Crit care med. 1997;25(9):1539-44.

Mutoh J. Positive end expiratory pressure affects redistribution of ventilation differently in prone and supine sheep. Crit care med. 2004;32(10):2039-44.

Voggenreiter G, Neudeck F, Aufmkolk M, Fabinder J. Intermittent prone positioning in the treatment of severe and moderate post traumatic lung injury. Crit care med. 1999;27(11):2375-82.

Pelosi P, Bottino N, Chiumello D, Caironi P, Panigada M, Gamberoni C, Colombo G. Sigh in supine and prone position during acute respiratory distress syndrome. Am J Respir Crit care med. 2003;167(4):521-7.

Pappert D, Rossaint R, Slama K. Influence of positioning on ventilation, perfusion relationships in severe adult respiratory distress syndrome. Chest. 1994;106:1511-6.

Johansson MJ, Wiklund A, Flatebo T, Nicolaysen A, Nicolaysen G, Walther SM. Positive end expiratory pressure affects regional redistribution of ventilation differently in prone and supine sheep. Crit care med. 2004;32(10):2039-44.

Gattinoni L, Vagginelli F, Carlesso E, Taccone P, Conte V, Chiumello D. Decrease in PCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Criti care med. 2003;31(12):2727-33.

Wagaman MJ, Shutack JG, Mommjian AS, Improved oxygenation and lung compliance with prone positioning of neonates. Paediatr. 1979;94(5):787-91.

Gattinoni L, Pesenti A, Bombino M, Baglioni S, Rivolta M,. Relationships between lung computed tomographic density gas exchange and PEEP in acute respiratory failure. Anaesthesiology. 1988;69:824-32.

Owens C. Computed tomography in established ARDS: Correlation with lung injury score. Chest. 1994;106:1815-21.

David DP, Lee L, Chiang HT, Lin SL, Ger LP, Kun MH, Yuh CT. Prone position ventilation induces sustained improvement in oxygenation in patients with ARDS who have a large shunt. Crit care med. 2003;30(7):1446-52.

www.nursingcenter.com. Prone positioning in acute lung injury. Journal of trauma-injury infection and critical care. 1998;45(4):849-52.

Pedroza J. The future of prone positioning in adult respiratory distress syndrome. 2000.

Rivara D. Positional hypoxaemia during artificial ventilation. Criti care med. 1984;12(5):436-8.

Gillespie DJ, Rehder K. Body position and ventilation-perfusion relationship in unilateral pulmonary disease. Chest. 1987;91:75-9.

Wong WP. Use of body positioning in the mechanically ventilated patient with acute respiratory failure. Application of Sacketts’s rules of evidence. Physiotherapy theory and Practise. 1999;15(1)

Downloads

Published

2017-01-10

How to Cite

Patil, P. S., & Nagarwala, R. (2017). A comparative study of supine lying, side lying and prone positioning on oxygen saturation, in mechanically ventilated patients, in acute respiratory failure. International Journal of Research in Medical Sciences, 3(7), 1627–1631. https://doi.org/10.18203/2320-6012.ijrms20150241

Issue

Section

Original Research Articles