Adverse Hemodynamic Effects of Lateral Rotation During Mechanical Ventilation

Abstract

Turning critically ill, mechanically ventilated patients every 2 hours is a fundamental nursing intervention to reduce the negative impact of prolonged immobility from preventable pulmonary complications such as ventilator-associated pneumonia and atelectasis. Unfortunately, when coupled with positive pressure ventilation, the benefits of turning may come at the expense of cardiovascular function. Clinicians should closely monitor the hemodynamic response to turning mechanically ventilated patients, and if compromise is observed, the degree and duration of compromise may provide guidance to the appropriate intervention.

Hemodynamic Instability: Is It Really a Barrier to Turning Critically Ill Patients?

“…21,22,[26][27][28][29][30][31][32] The third body of evidence is the most recent and includes studies of early mobility in critically ill patients that included data on feasibility, safety, and processes of care. [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] responsiveness, contributing to postural hypotension and tachycardia as a result of reductions in stroke volume and cardiac output. 8,9 Head motion alone can reduce cardiac reflex response to central stimulation of the carotid baroreceptors by 30%.…”

“…If we train patients to turn, thus preventing "prolonged gravitational return relative to an increase in intrathoracic pressure. 34 The addition of positive end-expiratory pressure can worsen that effect. 35 In one study, the impact on size and shape of the inferior vena cava was examined in response to position change in people without cardiac disease.…”

“…36 This finding is most likely due to the greater number of structures within the thoracic cavity that may create a larger compression effect while the person is in the lateral position. 34,37 Critically ill patients are hemodynamically affected by a position change. These effects can be mitigated by the careful planning of nursing care activities to reduce excess oxygen demand on the patient outside of the demand that will occur during a position change.…”

Manual Turns in Patients Receiving Mechanical Ventilation

“…Sustained lateral positioning may cause cardiovascular compromise in critically ill patients receiving mechanical ventilation. 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.…”

“…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 …”