Effect of Position and Posture on the Respiratory System

  • A. Broccard
  • J. J. Marini
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 1995)

Abstract

Gravitational stress and frequent changes of body position are integral to normal activity. Treatment in a critical care setting, however, often entails prolonged recumbency, unchanging position, and even complete ablation of skeletal muscle tone and spontaneous movement. Early mobilization and ambulation have become routine in post-operative management in order to prevent such post-surgical complications as atelectasis and pneumonia. In other critical care settings, however, relatively little attention has been paid to assuring frequent position changes, except for routine nursing care aimed at preventing cutaneous ulceration.

Keywords

Mercury Cage Pneumonia Immobilization Flare 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Fink MP, Helsmoortel CM, Stein KL, Lee PC, Cohn SM (1990) The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill victims of blunt trauma. A prospective study. Chest 97: 132–137PubMedCrossRefGoogle Scholar
  2. 2.
    Gentilello L, Thompson DA, Tonnesen AS, et al (1988) Effects of a rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med 16: 783–786PubMedCrossRefGoogle Scholar
  3. 3.
    Milic-Emilic J, Henderson JAM, Dolovich MB, Trop D, Kaneko K (1966) Regional distribution of inspired gas in the lung. J Appl Physiol 21: 749–759Google Scholar
  4. 4.
    Kaneko K, Milic-Emilic J, Dolovich MB, Downson A, Bates DV (1966) Regional distribution of ventilation and perfusion as a function of body position. J Appl Physiol 21: 767–777PubMedGoogle Scholar
  5. 5.
    Mutoh T, Guest RJ, Lamm WJE, Albert RK (1992) Prone position alters the effect of volume overload on regional pleural pressures and improves hypoxemia in pigs in vitro. Am Rev Respir Dis 146: 300–306PubMedGoogle Scholar
  6. 6.
    Amis TC, Jones AH, Hughes JMB (1984) Effect of posture on inter-regional distribution of pulmonary ventilation in man. Respir Physiol 56: 169–192PubMedCrossRefGoogle Scholar
  7. 7.
    Lumb AB, Nunn JF (1991) Respiratory function and ribcage contribution to ventilation in body positions commonly used during anesthesia. Anesth Analg 73: 422–426PubMedCrossRefGoogle Scholar
  8. 8.
    Rehder K, Knopp TJ, Sessler AD (1978) Regional intrapulmonary gas distribution in awake and anesthetized-paralyzed prone man. J Appl Physiol 45: 528–535PubMedGoogle Scholar
  9. 9.
    Orphanidou D, Hughes JMB, Myers MJ, Al-Suhali AR, Henderson B (1986) Tomography of regional ventilation and perfusion using krypton 81m in normal subjects and asthmatic patients. Thorax 41: 542–551PubMedCrossRefGoogle Scholar
  10. 10.
    Krayer S, Rehder K, Vetterman J, Didier EP, Ritman EL (1989) Position and motion of the diaphragm during anesthesia-paralysis. Anesthesiology 70: 891–898PubMedCrossRefGoogle Scholar
  11. 11.
    Klingstedt C, Hedenstierna G, Lundquist H, Strandberg A, Tokics L, Brismar B (1990) The influence of body position and differential ventilation on lung dimensions and atelectasis formation in anaesthetized man. Acta Anaesthesiol Scand 34: 315–322PubMedCrossRefGoogle Scholar
  12. 12.
    Mutoh T, Lamm WJE, Embree LJ, Hildebrandt J, Albert RK (1991) Abdominal distention alters regional pleural pressures and chest wall mechanics in pigs in vivo. J Appl Physiol 70: 2611–2618PubMedGoogle Scholar
  13. 13.
    Marini JJ, Tyler ML, Hudson LD, Davis BS (1984) Influence of head-dependent positions on lung volume and oxygen saturation in chronic air-flow obstruction. Am Rev Respir Dis 129: 101–105PubMedGoogle Scholar
  14. 14.
    Navajas D, Farre R, Rotger MM, Milic-Emili J, Sanchis J (1988) Effect of body posture on respiratory impedance. J Appl Physiol 64: 194–199PubMedGoogle Scholar
  15. 15.
    Craig DB, Wahba WM, Don HF, Couture JG, Becklake MR (1971) “Closing volume” and its relationship to gas exchange in seated and supine positions. J Appl Physiol 31: 717–721PubMedGoogle Scholar
  16. 16.
    Cortese DA, Rodarte JR, Rehder K, Hyatt RE (1976) Effect of posture on the singlebreath oxygen test in normal subjects. J Appl Physiol 41: 474–479PubMedGoogle Scholar
  17. 17.
    Rea HH, Withy SJ, Seelye ER, Harris EA (1977) The effects of posture on venous admixture and respiratory dead space in health. Am Rev Respir Dis 115: 571–579PubMedGoogle Scholar
  18. 18.
    Behrakis PK, Baydur A, Jaeger M, Milic-Emili J (1983) Lung mechanics in sitting and horizontal body positions. Chest 83: 643–646PubMedCrossRefGoogle Scholar
  19. 19.
    Estenne M, Yernault JC, De Troyer A (1985) Rib cage and diaphragm-abdomen compliance in humans: Effects of age and posture. J Appl Physiol 59: 1842–1848PubMedGoogle Scholar
  20. 20.
    Konno K, Mead J (1967) Measurements of separate volume changes of rib cage and abdomen during breathing. J Appl Physiol 22: 407–422PubMedGoogle Scholar
  21. 21.
    De Troyer A (1983) Mechanical role of the abdominal muscles in relation to posture. Respir Physiol 53: 341–353PubMedCrossRefGoogle Scholar
  22. 22.
    Roussos CS, Fukuchi Y, Macklem PT, Engel LA (1976) Influence of diaphragmatic contraction on ventilation distribution in horizontal man. J Appl Physiol 40: 417–424PubMedGoogle Scholar
  23. 23.
    Chevrolet JC, Martin JG, Flood R, Martin RR, Engel LA (1978) Topographical ventilation and perfusion distribution during IPPB in the lateral posture. Am Rev Respir Dis 118: 847–854PubMedGoogle Scholar
  24. 24.
    Chevrolet JC, Emrich J, Martin RR, Engel LA (1979) Voluntary changes in ventilation distribution in the lateral posture. Respir Physiol 38: 313–323PubMedCrossRefGoogle Scholar
  25. 25.
    Froese AB, Bryan AC (1974) Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 41: 242–255PubMedCrossRefGoogle Scholar
  26. 26.
    Rehder K, Knopp TJ, Sessler AD, Didier EP (1979) Ventilation-perfusion relationship in young healthy awake and anesthetized-paralyzed man. J Appl Physiol 47: 745–753PubMedGoogle Scholar
  27. 27.
    Hubmayr RD, Rodarte JR, Walters BJ, Tonelli FM (1987) Regional ventilation during spontaneous breathing and mechanical ventilation in dogs. J Appl Physiol 63: 2467–2475PubMedGoogle Scholar
  28. 28.
    West JB, Dollery CT (1960) Distribution of blood flow and ventilation perfusion ratio in the lung, measured with radioactive C0215. J Appl Physiol 15: 405–410PubMedGoogle Scholar
  29. 29.
    Hakim TS, Lisbona R, Dean GW (1987) Gravity-independent inequality in pulmonary blood flow in humans. J Appl Physiol 63: 1114–1121PubMedGoogle Scholar
  30. 30.
    Glenny RW, Lamm WJE, Albert RK, Robertson HT (1991) Gravity is a minor determinant of pulmonary blood distribution. J Appl Physiol 71: 620–629PubMedGoogle Scholar
  31. 31.
    Amis TC, Jones HA, Hughes JMB (1984) Effect of posture on interregional distribution of pulmonary perfusion and VA/Q ratios in man. Respir Physiol 56: 169–182PubMedCrossRefGoogle Scholar
  32. 32.
    Hughes JMB, Glazier JB, Maloney JE, West JB (1968) Effect of extra-alveolar vessels on distribution of blood flow in the dog lung. J Appl Physiol 25: 701–712PubMedGoogle Scholar
  33. 33.
    Préfaut C, Engel LA (1981) Vertical distribution of perfusion and inspired gas in supine man. Respir Physiol 43: 209–219PubMedCrossRefGoogle Scholar
  34. 34.
    Neumann PH, Kivlen CM, Johnson A, Minnear FL, Malik AB (1984) Effect of alveolar hypoxia on regional pulmonary perfusion. J Appl Physiol 56: 338–342PubMedGoogle Scholar
  35. 35.
    Maloney JE, Alcorn D, Cannata J, Walker A, Ritchie BC (1974) Regional vascular response to hypoxia in the lungs of anaesthetized sheep. Aust J Exp Biol Med Sci 52: 801–812PubMedCrossRefGoogle Scholar
  36. 36.
    Wiener CW, McKenna WJ, Myers MJ (1990) Left lower lobe ventilation is reduced in patients with cardiomegaly in the supine but not in the prone position. Am Rev Respir Dis 141: 150–155PubMedGoogle Scholar
  37. 37.
    Robin ED, Laman D, Horn BR, Theodore J (1976) Platypnea related to orthodeoxia caused by true vascular lung shunts. N Engl J Med 294: 941–943PubMedCrossRefGoogle Scholar
  38. 38.
    Ray JF III, Yost L, Moallem S, et al (1974) Immobility, hypoxemia, and pulmonary arteriovenous shunting. Arch Surg 109: 537–541PubMedCrossRefGoogle Scholar
  39. 39.
    Wahrenbrock EA, Carrico CJ, Schroeder CF, Trummer MJ (1970) The effect of posture on pulmonary function and survival of anesthetized dogs. J Surg Res 10: 13–18PubMedCrossRefGoogle Scholar
  40. 40.
    Summer WR, Curry P, Haponik EF, Nelson S, Elston R (1989) Continuous mechanical turning of intensive care unit patients shortens length of stay in some diagnostic-related groups. J Crit Care 4: 45–53CrossRefGoogle Scholar
  41. 41.
    Murai DT, Grant JW (1994) Continuous oscillation therapy improves the pulmonary outcome of intubated newborns: Results of a prospective, randomized, controlled trial. Crit Care Med 22: 1147–1154PubMedCrossRefGoogle Scholar
  42. 42.
    Hotchkiss JR Jr, Crooke PS, Adams AB, Marini JJ (1994) Implications of a biphasic two-compartment model of constant flow ventilation for the clinical setting. J Crit Care 9: 114–123PubMedCrossRefGoogle Scholar
  43. 43.
    Imsand C, Feihl F, Perret C, Fitting JW (1994) Regulation of inspiratory neuromuscular output during synchronized intermittent mechanical ventilation. Anesthesiology 80: 13–22PubMedCrossRefGoogle Scholar
  44. 44.
    Bynum LJ, Wilson JE III, Pierce AK (1976) Comparison of spontaneous and positive pressure breathing in supine normal subjects. J Appl Physiol 41: 341–347PubMedGoogle Scholar
  45. 45.
    Rehder K, Hatch DJ, Sessler AD, Fowler WS (1972) The function of each lung of anesthetized and paralyzed man during mechanical ventilation. Anesthesiology 37: 16–26PubMedCrossRefGoogle Scholar
  46. 46.
    Rehder K, Sessler AD, Rodarte JR (1977) Regional intrapulmonary gas distribution in awake and anesthetized paralyzed man. J Appl Physiol 42: 391–402PubMedGoogle Scholar
  47. 47.
    Rehder K, Knopp TJ, Brusasco J, Dider EP (1981) Inspiratory flow and intrapulmonary gas distribution. Am Rev Respir Dis 124: 392–396PubMedGoogle Scholar
  48. 48.
    Landmark SJ, Knopp TJ, Rehder K, Sessler AD (1977) Regional pulmonary perfusion and V/Q in awake and anesthetized-paralyzed man. J Appl Physiol (Respir) 43: 993–1000Google Scholar
  49. 49.
    Schuster DP, Howard DK (1994) The effect of positive end-expiratory pressure on regional pulmonary perfusion during acute lung injury. J Crit Care 9: 100–110PubMedCrossRefGoogle Scholar
  50. 50.
    Dhainaut JF, Bons J, Bricard C, Monsallier JF (1980) Improved oxygenation in patients with extensive unilateral pneumonia using the lateral decubitus position. Thorax 35: 792–793PubMedCrossRefGoogle Scholar
  51. 51.
    Seaton D, Lapp NL, Morgan WK (1979) Effect of body position on gas exchange after thoracotomy. Thorax 34: 518–522PubMedCrossRefGoogle Scholar
  52. 52.
    Gillespie DJ, Rehder K (1987) Body position and ventilation-perfusion relationships in unilateral pulmonary disease. Chest 91: 75–79PubMedCrossRefGoogle Scholar
  53. 53.
    Winslow EH, Clark AP, White KM, Tyler DO (1990) Effects of a lateral turn on mixed venous oxygen saturation and heart rate in critically ill adults. Heart Lung 19: 557–561PubMedGoogle Scholar
  54. 54.
    Hasan FM, Beller TA, Sobonya RE, Heller N, Brown GW (1982) Effect of positive end- expiratory pressure and body position in unilateral lung injury. J Appl Physiol 52: 147–154PubMedGoogle Scholar
  55. 55.
    Shim C, Chun KJ, Williams MH Jr, Blaufox MD (1986) Positional effects on distribution of ventilation in chronic obstructive pulmonary disease. Ann Intern Med 105: 346–350PubMedGoogle Scholar
  56. 56.
    Gillespie DJ, Rehder K (1989) Effect of positional change on ventilation-perfusion distribution in unilateral pleural effusion. Intensive Care Med 15: 266–268PubMedCrossRefGoogle Scholar
  57. 57.
    Anthonisen NR, Martin RR (1977) Regional lung function in pleural effusion. Am Rev Respir Dis 116: 201–207PubMedGoogle Scholar
  58. 58.
    Chang SC, Chang HI, Shiao GM, Perng RP (1993) Effect of body position on gas exchange in patients with unilateral central airway lesions. Chest 103: 787–791PubMedCrossRefGoogle Scholar
  59. 59.
    Jönsson E, Mossberg B (1984) Impairment of ventilatory function by supine posture in asthma. Eur J Respir Dis 65: 496–503PubMedGoogle Scholar
  60. 60.
    Brenner BE, Abraham E, Simon RR (1983) Position and diaphoresis in acute asthma. Am J Med 74: 1005–1009PubMedCrossRefGoogle Scholar
  61. 61.
    Albert RK, Leasa D, Sanderson M, Robertson HT, Hlastala MP (1987) The prone position improves arterial oxygenation and reduces shunt in oleic-acid-induced acute lung injury. Am Rev Respir Dis 135: 628–633PubMedGoogle Scholar
  62. 62.
    Wiener CM, Kirk W, Albert RK (1990) Prone position reverses gravitational distribution of perfusion in dog lungs with oleic acid-induced injured. J Appl Physiol 68: 1386–1392PubMedCrossRefGoogle Scholar
  63. 63.
    Lamm WJE, Graham MM, Albert RK (1994) Mechanism by which the prone position improves oxygenation in acute lung injury. Am J Respir Crit Care Med 150: 184–193PubMedGoogle Scholar
  64. 64.
    Gattinoni L, Pesenti A, Bombino M, et al (1988) Relationships between lung computed tomographic density, gas exchange and PEEP in acute respiratory failure. Anesthesiology 69: 824–832PubMedCrossRefGoogle Scholar
  65. 65.
    Gattinoni L, D’Andrea L, Pelosi P, Vitale G, Pesenti A, Fumagalli R (1993) Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA 269: 2122–2127PubMedCrossRefGoogle Scholar
  66. 66.
    Gattinoni L, Pelosi P, Valenza F, Mascheroni M (1994) Patient positioning in acute respiratory disease. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, pp 1067–1076Google Scholar
  67. 67.
    Brüssel T, Hachenberg T, Roos N, Lemzem H, Konertz W, Lawin P (1993) Mechanical ventilation in the prone position for acute respiratory failure after cardiac surgery. J Cardiothor Vasc Anesth 7: 541–546CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • A. Broccard
  • J. J. Marini

There are no affiliations available

Personalised recommendations