The Airway and Lungs

  • Martin W. DünserEmail author
  • Daniel Dankl
  • Sirak Petros
  • Mervyn Mer


Extremely useful and relevant information can be obtained when analysing the position assumed by patients with dyspnoea. Relief of breathlessness in a sitting or standing position compared to the recumbent position is referred to as orthopnoea. While increased venous return in the supine patient is well tolerated in individuals with a preserved heart function, this leads to pulmonary venous congestion, an increase in interstitial lung water and a subsequent reduction of lung capacities with resultant shortness of breath in patients with impaired heart function. Accordingly, patients with heart failure prefer to sit upright (e.g. supporting their back with pillows to achieve a maximum upright position) (Fig. 5.1). Conversely, placing the patient into a supine position may be used as a stress test to exclude respiratory distress due to heart failure or (pulmonary) fluid overload. A history of paroxysmal nocturnal dyspnoea characterized by repeated awakening due to breathlessness while sleeping in the recumbent position is a typical symptom of heart failure.


  1. 1.
    Vazquez R, Gheorghe C, Ramos F, Dadu F, Amoateng-Adjepong Y, Manthous CA (2010) Gurgling breath sounds may predict hospital-acquired pneumonia. Chest 138:284–288CrossRefPubMedGoogle Scholar
  2. 2.
    Sitzwohl C, Langheinrich A, Schober A, Krafft P, Sessler DI, Herkner H, Gonano C, Weinstabl C, Kettner SC (2010) Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomized trial. BMJ 341:c5943CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Martin W. Dünser
    • 1
    Email author
  • Daniel Dankl
    • 2
  • Sirak Petros
    • 3
  • Mervyn Mer
    • 4
  1. 1.Department of Anesthesiology and Intensive Care MedicineKepler University Hospital, Johannes Kepler University LinzLinzAustria
  2. 2.Department of Anesthesiology, Perioperative Medicine and General Intensive CareSalzburg University Hospital and Paracelsus Private Medical UniversitySalzburgAustria
  3. 3.Medical Intensive Care Unit and Centre of Haemostaseology, University Hospital LeipzigLeipzigGermany
  4. 4.Divisions of Critical Care and Pulmonology, Department of MedicineCharlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of the WitwatersrandJohannesburgSouth Africa

Personalised recommendations