Physiologic Effects of Steep Positioning in the Surgical Intensive Care Unit

Acute effects of continuous rotational therapy on ventilation-perfusion inequality in lung injury

“…Similarly, Nelson and co-workers [19] did not observe adverse effects on hemodynamics in hemodynamically stable patients during rotation. In contrast, a prolonged extreme lateral posture (62 °) might produce significant, and even adverse, effects on the cardiovascular system.…”

“…In a prospective investigation [18], Banasik et al could not find a beneficial effect of intermittent lateral positioning on oxygenation in postoperative cardiac surgery patients. Similarly, Nelson and co-workers [19] did not observe an increase in PaO 2 by the simple lateral positioning of mechanically ventilated patients with symmetric lung disease.…”

“…In our patients we also noticed a reduced amount of dispersion in the logarithmic distribution of pulmonary blood flow (logSDa), which was not reported on in the paper by Pappert et al The net effect of the reduced shunt and mismatch resulted in a similarly large improvement in oxygenation in our study (A PaO2/FIO2:43 mm Hg) as in the study by Pappert et al (APaO2/FIO2: 48 mm Hg). The continuous moving of patients using a rotating bed seems to be more beneficial than intermittent semi-decubitus positioning, since it was demonstrated in recent studies [18,19] that the maneuver of periodic positional changes by simply using pillows to prop patients off their backs failed to improve oxygenation in most patients.…”

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

“…Although effects on oxygenation in patients with unilateral lung pathology have been studied, [13][14][15][16][17] only the immediate effect is reported (ie, less than 30 minutes). Due to the age of many of the randomized studies assessing lateral positioning, 13,[15][16][17][18][19] ventilation methods are outdated. Additionally, study sample sizes are small and little information is provided on changes in respiratory mechanics or hemodynamics after positioning.…”

Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore

“…[8] Although radiographically and by deÞ nition, ARDS is a bilateral lung disease, blood oxygenation (PaO 2 ) in 5 of the 6 studied patients differed during lateral positioning, suggesting asymmetric lung involvement. [9] Since variable effects on oxygenation during lateral positioning of patients have been reported, [4,[10][11][12][13] the effects of lateral positioning of ARDS patients are unclear. After extensive literature search, we did not find a method to quantify or predict the asymmetry of the lung disease.…”