Lateral positioning for critically ill adult patients

Hewitt, Nicky; Bucknall, Tracey; Faraone, Nardene M.

doi:10.1002/14651858.cd007205.pub2

Cited by 32 publications

(30 citation statements)

References 77 publications

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“…Our results provide quantitative data on blood flow distribution that help explain the drop in partial oxygen pressure seen in patients with acute respiratory distress syndrome (ARDS) in the lateral position, with the most affected lung in the dependent position [26, 28]. Lateral position PBVV, and PVDR, are novel measures which may theoretically correlate with left atrial pressure through venous distension.…”

Section: Discussionmentioning

confidence: 99%

Supine, prone, right and left gravitational effects on human pulmonary circulation

Wieslander

Ramos

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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BackgroundBody position can be optimized for pulmonary ventilation/perfusion matching during surgery and intensive care. However, positional effects upon distribution of pulmonary blood flow and vascular distensibility measured as the pulmonary blood volume variation have not been quantitatively characterized. In order to explore the potential clinical utility of body position as a modulator of pulmonary hemodynamics, we aimed to characterize gravitational effects upon distribution of pulmonary blood flow, pulmonary vascular distension, and pulmonary vascular distensibility.MethodsHealthy subjects (n = 10) underwent phase contrast cardiovascular magnetic resonance (CMR) pulmonary artery and vein flow measurements in the supine, prone, and right/left lateral decubitus positions. For each lung, blood volume variation was calculated by subtracting venous from arterial flow per time frame.ResultsBody position did not change cardiac output (p = 0.84). There was no difference in blood flow between the superior and inferior pulmonary veins in the supine (p = 0.92) or prone body positions (p = 0.43). Compared to supine, pulmonary blood flow increased to the dependent lung in the lateral positions (16–33%, p = 0.002 for both). Venous but not arterial cross-sectional vessel area increased in both lungs when dependent compared to when non-dependent in the lateral positions (22–27%, p ≤ 0.01 for both). In contrast, compared to supine, distensibility increased in the non-dependent lung in the lateral positions (68–113%, p = 0.002 for both).ConclusionsCMR demonstrates that in the lateral position, there is a shift in blood flow distribution, and venous but not arterial blood volume, from the non-dependent to the dependent lung. The non-dependent lung has a sizable pulmonary vascular distensibility reserve, possibly related to left atrial pressure. These results support the physiological basis for positioning patients with unilateral pulmonary pathology with the “good lung down” in the context of intensive care. Future studies are warranted to evaluate the diagnostic potential of these physiological insights into pulmonary hemodynamics, particularly in the context of non-invasively characterizing pulmonary hypertension.

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Section: Discussionmentioning

confidence: 99%

Supine, prone, right and left gravitational effects on human pulmonary circulation

Wieslander

Ramos

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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“… 5 , 6 Lateral position may be also associated with beneficial effects on gas exchange, especially in unilateral widespread infiltrates. 7 Finally, a recent experience demonstrated that awake, early self-proning improves oxygen saturation in patients with COVID-19. 8 The objective of this study was to evaluate the efficacy of both prone and lateral positioning in patients who undergo helmet CPAP because of hARF that is caused by COVID-19 pneumonia.…”

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confidence: 99%

Prone and Lateral Positioning in Spontaneously Breathing Patients With COVID-19 Pneumonia Undergoing Noninvasive Helmet CPAP Treatment

Retucci

Aliberti

Ceruti

et al. 2020

Chest

110

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“…All nine animals (32.2 ± 1.2 kg) completed the study protocol. Before commencement of the study, the animals were ventilated as follows: V T 8.1 [7.9-8.1] ml/kg, RR 28 [24][25][26][27][28] ference from baseline to 3 h (∆LUS) of the non-infected lung (left lung) worsened significantly during left-lateral position (+ 5.44 ± 1.07; p = 0.005), whereas it remained stable when the animal was placed in the right-lateral position (− 0.67 ± 1.20; p = 0.55), as summarised in Fig. 2.…”

Section: Resultsmentioning

confidence: 99%

“…In particular, we found a driving pressure in the range of 9 cm H 2 O suggesting low risk for ventilator-induced lung injury in this model of mono-lateral pneumonia. Nevertheless, pulmonary mechanics could be unspecific in monitoring lung injury in this model, and clinical data are needed to evaluate potential association of lateral position with lung injury and clinically-relevant outcomes 26 . Similarly, in line with previous data 27 , hemodynamic measurements did not differ between positions.…”

Section: Discussionmentioning

confidence: 99%

Lateral position during severe mono-lateral pneumonia: an experimental study

Meli

Viñas

Battaglini

et al. 2020

Sci Rep

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Patients with mono-lateral pneumonia and severe respiratory failure can be positioned in lateral decubitus, with the healthy lung dependent, to improve ventilation-perfusion coupling. Oxygenation response to this manoeuvre is heterogeneous and derecruitment of dependent lung has not been elucidated. Nine pigs (32.2 ± 1.2 kg) were sedated and mechanically ventilated. Mono-lateral right-sided pneumonia was induced with intrabronchial challenge of Pseudomonas aeruginosa. After 24 h, lungs were recruited and the animals were randomly positioned on right or left side. After 3 h of lateral positioning, the animals were placed supine; another recruitment manoeuvre was performed, and the effects of contralateral decubitus were assessed. Primary outcome was lung ultrasound score (LUS) of the dependent lung after 3-h lateral positioning. LUS of the left non-infected lung worsened while positioned in left-lateral position (from 1.33 ± 1.73 at baseline to 6.78 ± 4.49; p = 0.005). LUS of the right-infected lung improved when placed upward (9.22 ± 2.73 to 6.67 ± 3.24; p = 0.09), but worsened in right-lateral position (7.78 ± 2.86 to 13.33 ± 3.08; p < 0.001). PaO2/FiO2 improved in the left-lateral position (p = 0.005). In an animal model of right-lung pneumonia, left-lateral decubitus improved oxygenation, but collapsed the healthy lung. Right-lateral orientation further collapsed the diseased lung. Our data raise potential clinical concerns for the use of lateral position in mono-lateral pneumonia.

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Lateral positioning for critically ill adult patients

Cited by 32 publications

References 77 publications

Supine, prone, right and left gravitational effects on human pulmonary circulation

Supine, prone, right and left gravitational effects on human pulmonary circulation

Prone and Lateral Positioning in Spontaneously Breathing Patients With COVID-19 Pneumonia Undergoing Noninvasive Helmet CPAP Treatment

Lateral position during severe mono-lateral pneumonia: an experimental study

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