Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients

Mezidi, Mehdi; Guérin, Claude

doi:10.21037/atm.2018.05.50

Cited by 61 publications

(56 citation statements)

References 35 publications

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“…Various physiological changes may be implicated by the occurrence of blood oxygen desaturation during DNPs. Patient mobilization is one of the most important, and in particular lateralization, which can induce a decrease in lung compliance, alveolar derecruitment, mobilization of respiratory-tract secretions, airway irritations and coughing, ventilator-patient asynchrony [10,[23][24][25][26], and an increase in oxygen consumption [5,6]. All those physiological events could be induced by mobilization itself and/or the stress response associated with pain [10,[27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Automated vs. conventional ventilation in the ICU: a randomized controlled crossover trial comparing blood oxygen saturation during daily nursing procedures (I-NURSING)

et al. 2020

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Background: Hypoxia is common during daily nursing procedures (DNPs) routinely performed on mechanically ventilated patients. The impact of automated ventilation on the incidence and severity of blood oxygen desaturation during DNPs remains unknown. Methods: A prospective randomized controlled crossover trial was carried out in a French intensive care unit to compare blood oxygen pulse saturation (SpO 2) during DNPs performed on patients mechanically ventilated in automated and conventional ventilation modes (AV and CV, respectively). All patients with FiO 2 ≤ 60% and without prone positioning or neuromuscular blocking agents were included. Patients underwent two DNPs on the same day using AV (INTELLiVENT-ASV®) and CV (volume control, biphasic positive airway pressure, or pressure support ventilation) in a randomized order. The primary outcome was the percentage of time spent with SpO 2 in the acceptable range of 90-95% during the DNP. Results: Of the 265 included patients, 93% had been admitted for a medical pathology, the majority for acute respiratory failure (52%). There was no difference between the two periods in terms of DNP duration, sedation requirements, or ventilation parameters, but patients had more spontaneous breaths and lower peak airway pressures during the AV period (p < 0.001). The percentage of time spent with SpO 2 in the acceptable range during DNPs was longer in the AV period than in the CV period (48 ± 37 vs. 43 ± 37, percentage of DNP period; p = 0.03). After adjustment, AV was associated with a higher number of DNPs carried out with SpO 2 in the acceptable range (odds ratio, 1.82; 95% CI, 1.28 to 2.6; p = 0.001) and a lower incidence of blood oxygen desaturation ≤ 85% (adjusted odds ratio, 0.50; 95% CI, 0.30 to 0.85; p = 0.01).

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Section: Discussionmentioning

confidence: 99%

Automated vs. conventional ventilation in the ICU: a randomized controlled crossover trial comparing blood oxygen saturation during daily nursing procedures (I-NURSING)

et al. 2020

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“…Prone positioning is thought to be a beneficial strategy for patients with ARDS as it allows for greater chest wall expansion than the supine position, thereby improving alveolar recruitment and the ventilation/perfusion ratio. These benefits are thought to improve survival outcomes owing to improved oxygenation and reduced lung injury[ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Two mechanically ventilated cases of COVID-19 successfully managed with a sequential ventilation weaning protocol: Two case reports

Peng¹,

Ren²,

Liu³

et al. 2020

WJCC

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BACKGROUND Patients with critical coronavirus disease 2019 (COVID-19), characterized by respiratory failure requiring mechanical ventilation (MV), are at high risk of mortality. An effective and practical MV weaning protocol is needed for these fragile cases. CASE SUMMARY Here, we present two critical COVID-19 patients who presented with fever, cough and fatigue. COVID-19 diagnosis was confirmed based on blood cell counts, chest computed tomography (CT) imaging, and nuclei acid test results. To address the patients’ respiratory failure, they first received noninvasive ventilation (NIV). When their condition did not improve after 2 h of NIV, each patient was advanced to MV [tidal volume (Vt), 6 mL/kg ideal body weight (IBW); 8-10 cmH 2 O of positive end-expiratory pressure; respiratory rate, 20 breaths/min; and 40%-80% FiO 2 ] with prone positioning for 12 h/day for the first 5 d of MV. Extensive infection control measures were conducted to minimize morbidity, and pharmacotherapy consisting of an antiviral, immune-enhancer, and thrombosis prophylactic was administered in both cases. Upon resolution of lung changes evidenced by CT, the patients were sequentially weaned using a weaning screening test, spontaneous breathing test, and airbag leak test. After withdrawal of MV, the patients were transitioned through NIV and high-flow nasal cannula oxygen support. Both patients recovered well. CONCLUSION A MV protocol attentive to intubation/extubation timing, prone positioning early in MV, infection control, and sequential withdrawal of respiratory support, may be an effective regimen for patients with critical COVID-19.

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“…In the lateral recumbent, Flower's position and supine, the test subjects had their heads resting on a pillow. Only the right lateral recumbent was included without the left one, because the bilateral respiratory movements have been proved to be similar [25]. At each posture, the test was repeated twice in order to investigate the repeatability.…”

Section: Measurement Proceduresmentioning

confidence: 99%

“…The lung has the largest volume capacity at the sitting posture [31]. In lateral recumbent posture, lung and chest wall compliances decrease, which limits the amplitude of thoracic respiration movement [25]. Small respiratory movement amplitude could result in miscounting of RR.…”

Section: Rr Measurements At Different Body Posturesmentioning

confidence: 99%

Clinical Evaluation of Stretchable and Wearable Inkjet-Printed Strain Gauge Sensor for Respiratory Rate Monitoring at Different Body Postures

et al. 2020

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Respiratory rate (RR) is a vital sign with continuous, convenient, and accurate measurement which is difficult and still under investigation. The present study investigates and evaluates a stretchable and wearable inkjet-printed strain gauge sensor (IJP) to estimate the RR continuously by detecting the respiratory volume change in the chest area. As the volume change could cause different strain changes at different body postures, this study aims to investigate the accuracy of the IJP RR sensor at selected postures. The evaluation was performed twice on 15 healthy male subjects (mean ± SD of age: 24 ± 1.22 years). The RR was simultaneously measured in breaths per minute (BPM) by the IJP RR sensor and a reference RR sensor (e-Health nasal thermal sensor) at each of the five body postures namely standing, sitting at 90°, Flower’s position at 45°, supine, and right lateral recumbent. There was no significant difference in measured RR between IJP and reference sensors, between two trials, or between different body postures (all p > 0.05). Body posture did not have any significant effect on the difference of RR measurements between IJP and the reference sensors (difference <0.01 BPM for each measurement in both trials). The IJP sensor could accurately measure the RR at different body postures, which makes it a promising, simple, and user-friendly option for clinical and daily uses.

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Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients

Cited by 61 publications

References 35 publications

Automated vs. conventional ventilation in the ICU: a randomized controlled crossover trial comparing blood oxygen saturation during daily nursing procedures (I-NURSING)

Automated vs. conventional ventilation in the ICU: a randomized controlled crossover trial comparing blood oxygen saturation during daily nursing procedures (I-NURSING)

Two mechanically ventilated cases of COVID-19 successfully managed with a sequential ventilation weaning protocol: Two case reports

Clinical Evaluation of Stretchable and Wearable Inkjet-Printed Strain Gauge Sensor for Respiratory Rate Monitoring at Different Body Postures

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