The description of different ventilation during postural change

1. Dott. Ftr Angelo Longoni
Master in Fisioterapia e Riabilitazione Respiratoria
Variazione della
ventilazione
nei cambi posturali
Riabilitazione Specialistica Cardio-respiratoria e Neuromotoria
Mariano Comense

2. Physiological effects of Positioning
Optimizes oxygen transport by improving V/Q
mismatch
Increases lung volumes
Reduces the work of breathing
Minimizes the work of heart
Enhances mucociliary clearance (postural drainage)

3. Positioning
Positioning restores ventilation to dependent
lung regions more effectively than PEEP or
large tidal volumes (Froese & Bryan, 1974).
Positioning has a marked influence on gas
exchange because of unevenly damaged lungs
(Tobin, 1994).
Side lying reduces lung densities in the upper
most lung (Brismar, 1985).

4. Right side lying may be more beneficial for
cardiac output than left side lying (Wong, 1998).
Simply turning from supine to side lying can
clear atelectasis from dependent regions
(Brismar, 1985).
Positioning affects lung volume
Lung volume is related to the position of the
diaphragm
FRC decreases from standing to slumped sitting
to supine (Macnaughton, 1995)

5. Positioning affects compliance (Wahba et al found
that work of breathing is 40% higher in supine
than in sitting)
Positioning affects arterial oxygenation by
improving V/Q mismatch (V/Q is usually
mismatched if the affected lung is dependent-
Gillespie et al)
“Bad lung up” position

7. La FRC si riduce passando dalla posizione eretta (seduta) a
quella supina: la spinta del contenuto addominale sul diaframma
limita l’espansione del torace. Rappresenta il punto di equilibrio
tra fase in-espiratoria.

8. Dispositivi utilizzati
1 Spirometro 3 Flussimetro
2 MIP/MEP 4 Life Shirt

9. Posture utilizzate
60/70° 90° 120° 140/150° SUPINO

10. La migliore di tre prove in tutte le posture
1 Spirometria

12. Curva flusso-volume
Normale
Restrittiva
Ostruttiva

13. 1 2 3 4 5

14. 1
°
S
E
R
I
E
2
°
S
E
R
I
E

15. 2MIP

16. MEP

17. MEP MIP
149 103
89 69
72 62
60 49 MIP
MEP
Fianco sx: 89 Fianco sx: 83
Fianco dx: 88 44 43 Fianco dx: 78

18. 3 PEF

20. PEF
850
670
Fianco sx: 650 Fianco dx: 630
600
550
500

21. 4 Life Shirt
(pletismografia induttiva cardio respiratoria)
ECG

22. Life Shirt
1
Respiro completo 2
3
Respiro toracico
Respiro addominale

23. Life Shirt
1 2 3
4 5

25. 32484 ml
30579 ml
29203 ml 32988 ml

29. Ventilatory Responses in the Intubated Patient
• Zafiropoules B et al (2004)
• 21 Subjects (mean = 71 years) following
abdo surgery requiring PSV
• Mobilised whilst intubated via ET tube
• Supine, sitting over edge of bed, standing,
walking on spot for 1 min, SOOB (initially),
SOOB after 20 mins.

30. Zafiropoules et al (2004) Physiological responses
to the early mobilisation of the intubated,
ventilated absominal surgery patient. Aust. Journal
of Physiotherapy, 50, 95-100
95-
Supine Sitting Stand WOS SOOB1 SOOB
on 1 min 20
edge
VT 712.5 826.8 883.4 904.3 873.1 710.0
(mls)
RR 21.4 24.3 24.9 26.8 26.1 20.3
b/pm
VE 15.1 19.6 21.3 22.8 22.2 13.8
l/min

31. GRAZIE DELL’ ATTENZIONE