Peter Thomas1, Jennifer Paratz2, Jeffrey Lipman3. 1. Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia. Electronic address: PeterJ_Thomas@health.qld.gov.au. 2. Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia. 3. Burns Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia; Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Abstract
OBJECTIVES: To compare the effect of semi-recumbent and sitting positions on gas exchange, respiratory mechanics and hemodynamics in patients weaning from mechanical ventilation. BACKGROUND: Upright positions are encouraged during rehabilitation of the critically ill but there effects have not been well described. METHODS: A prospective, randomized, cross-over trial was conducted. Subjects were passively mobilized from supine into a seated position (out of bed) and from supine to a semi-recumbent position (>45° backrest elevation in bed). Arterial blood gas (PaO2/FiO2, PaO2, SaO2, PaCO2 and A-a gradient), respiratory mechanics (VE,VT, RR, Cdyn, RR/VT) and hemodynamic measurements (HR, MABP) were collected in supine and at 5 min and 30 min after re-positioning. RESULTS:Thirty-four intubated and ventilated subjects were enrolled. The angle of backrest inclination in sitting (67 ± 5°) was greater than gained with semi-recumbent positioning (50 ± 5°, p < 0.001). There were no clinically important changes in arterial blood gas, respiratory mechanic or hemodynamic values due to either position. CONCLUSIONS: Neither position resulted in significant changes in respiratory and hemodynamic parameters. Both positions can be applied safely in patients being weaned from ventilation. Crown
RCT Entities:
OBJECTIVES: To compare the effect of semi-recumbent and sitting positions on gas exchange, respiratory mechanics and hemodynamics in patients weaning from mechanical ventilation. BACKGROUND: Upright positions are encouraged during rehabilitation of the critically ill but there effects have not been well described. METHODS: A prospective, randomized, cross-over trial was conducted. Subjects were passively mobilized from supine into a seated position (out of bed) and from supine to a semi-recumbent position (>45° backrest elevation in bed). Arterial blood gas (PaO2/FiO2, PaO2, SaO2, PaCO2 and A-a gradient), respiratory mechanics (VE,VT, RR, Cdyn, RR/VT) and hemodynamic measurements (HR, MABP) were collected in supine and at 5 min and 30 min after re-positioning. RESULTS: Thirty-four intubated and ventilated subjects were enrolled. The angle of backrest inclination in sitting (67 ± 5°) was greater than gained with semi-recumbent positioning (50 ± 5°, p < 0.001). There were no clinically important changes in arterial blood gas, respiratory mechanic or hemodynamic values due to either position. CONCLUSIONS: Neither position resulted in significant changes in respiratory and hemodynamic parameters. Both positions can be applied safely in patients being weaned from ventilation. Crown
Authors: Cheryl Elizabeth Hickmann; Diego Castanares-Zapatero; Emilie Bialais; Jonathan Dugernier; Antoine Tordeur; Lise Colmant; Xavier Wittebole; Giuseppe Tirone; Jean Roeseler; Pierre-François Laterre Journal: Ann Intensive Care Date: 2016-08-24 Impact factor: 6.925