25/04/2013

Dott. Ftr Angelo Longoni

Physiological effects of Positioning

Master in Fisioterapia e Riabilitazione Respiratoria

Variazione della
ventilazione
nei cambi posturali

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)

Riabilitazione Specialistica Cardio-respiratoria e Neuromotoria

Mariano Comense

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).

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)

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 dependentGillespie et al)
Bad lung up position

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La FRC si riduce passando dalla posizione eretta (seduta) a

quella supina: la spinta del contenuto addominale sul diaframma
limita lespansione del torace. Rappresenta il punto di equilibrio
tra fase in-espiratoria.

Dispositivi utilizzati
1 Spirometro

2 MIP/MEP

Posture utilizzate

60/70

90

120

140/150

3 Flussimetro

4 Life Shirt

La migliore di tre prove in tutte le posture

SUPINO

1 Spirometria

Curva flusso-volume
Normale
Restrittiva

Ostruttiva

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S
E
R
I
E

S
E
R
I
E

2MIP

MEP

MEP

MIP

149

103

89

69

72

62

60

49

3 PEF

MIP
Fianco sx: 83

Fianco sx: 89
Fianco dx: 88

MEP

44

43

Fianco dx: 78

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PEF

850
670
Fianco sx: 650

Fianco dx: 630

600
550
500

Life Shirt

4 Life Shirt

(pletismografia induttiva cardio respiratoria)

1
Respiro completo

ECG

Respiro toracico

3
Respiro addominale

Life Shirt

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32484 ml

29203 ml

30579 ml

32988 ml

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.

Zafiropoules et al (2004) Physiological responses

to the early mobilisation of the intubated,
ventilated absominal surgery patient. Aust. Journal
of Physiotherapy, 50, 95-100
Supine Sitting
on
edge

VT
(mls)

Stand

WOS
1 min

SOOB1 SOOB
20

712.5 826.8 883.4 904.3 873.1 710.0

RR
21.4
b/pm

24.3

24.9

26.8

26.1

20.3

VE
l/min

19.6

21.3

22.8

22.2

13.8

15.1

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GRAZIE DELL ATTENZIONE