Effect of Patient Position on Respiratory System in Adult and Pediatric Intensive Care Units

Öz

Physiotherapy applications are frequently used in intensive care units in order to minimize risk of complications and negative effects of immobilization, invasive treatments such as mechanical ventilation treatment. One basic component of these applications is positioning, which is based on changing body position according to gravity. Primary goal of positioning applications in immobile and critically ill patients is to maintain and improve oxygen delivery and tissue oxygenation. With positioning, improvements in respiratory system physiology and mechanics are aimed with increased ventilation and oxygenation, compatible ventilation/perfusion, prevention of atelectasis and prevention of ventilatoryassociated pneumonia. Fot these reasons, supine, prone, high supine lying to certain degrees, lateral positioning and continuous lateral rotation treatment can be applied in intensive care units. The risk of complications can be minimized and respiratory activities can be improved with positioning which is suitable for patient and the disease

Anahtar Kelimeler

• Intensive care
• neonatal
• positioning
• pulmonary function
• pediatrics

Yetişkin ve Pediatrik Yoğun Bakım Ünitelerinde Hasta Pozisyonlamanın Solunum Sistemine Etkisi

Öz

Yoğun bakım ünitelerinde immobilizasyonun olumsuz etkilerini ve mekanik ventilasyon tedavisine bağlı komplikasyonları minimuma indirmek amacıyla fizyoterapi uygulamalarından sıklıkla faydalanılmaktadır. Bu uygulamaların bir ana bileşeni ise vücut pozisyonunun graviteye göre değiştirilmesi temeline dayanan pozisyonlama tedavisidir. İmmobil ve kritik durumdaki hastalarda pozisyonlama uygulamalarının birincil hedefi, oksijen iletimini ve doku oksijenasyonunu korumak ve iyileştirmektir. Pozisyonlama uygulamalarıyla amaçlanan diğer etkiler ventilasyonda artış, uyumlu ventilasyon/perfüzyon oranı, atelektazinin önlenmesi ve ventilatör ilişkili pnömoninin önlenmesidir. Böylece solunum sistemi fizyolojisi ve mekaniğinde iyileşmeler meydana gelecektir. Bu doğrultuda sırtüstü, yüzüstü, belirli derecelerde yüksek sırtüstü yatış, lateral pozisyonlama ve sürekli lateral rotasyon tedavisi yoğun bakım ünitelerinde uygulanabilmektedir. Hastaya ve hastalığa uygun pozisyonlama uygulamalarıyla komplikasyon riski en aza indirilebilir ve solunumsal faaliyetler iyileştirilebilir.

Anahtar Kelimeler

• Pediatri
• yenidoğan
• pozisyonlama
• pulmoner fonksiyon
• yoğun bakım.

Kaynakça

1. Barros-Poblete M, Bernardes Neto SC, Benavides-Cordoba V, Vieira RP, Baz M, Martí, JD, Torres-Castro R. Early mobilization in intensive care unit in Latin America: A survey based on clinical practice. Frontiers in medicine. 2022;9:3376. DOI: 10.3389/fmed.2022.1005732
2. Knight J, Nigam Y, Jones A. Effects of bedrest 1: cardiovascular, respiratory and haematological systems. Nurs. Times. 2009;105(21):16-20.
3. Uçgun İ. Mekanik ventilasyon komplikasyonları. Yoğun Bakım Dergisi. 2008;8(1):44-59.
4. Ou GWM, Ng MJH, Ng CLW, Ong HK, Jayachandran B, Palanichamy V. Physiotherapy Practice Pattern in the Adult Intensive Care Units of Singapore–A Multi-Centre Survey. Proceedings of Singapore Healthcare. 2022;20101058211068589. DOI: 10.1177/20101058211068589
5. Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013;144(3):825-847. DOI: 10.1378/chest.12-2930
6. Hewitt N, Bucknall T, Faraone NM. Lateral positioning for critically ill adult patients. Cochrane Database Syst. Rev. 2016;(5). DOI: 10.1002/14651858. CD007205.pub2
7. Baysal E, Midilli TS, Ergin E. Effects of Different Position Changes on Hemodynamic Parameters and Dyspnea Severity in Patients with Dyspnea. Clin Exp Health Sci. 2018;8(4):261-267.
8. Pathmanathan N, Beaumont N, Gratrix A. Respiratory physiotherapy in the critical care unit. Continuing Education in Anaesthesia, Critical Care & Pain. 2015;15(1):20-25. DOI:10.1093/bjaceaccp/mku005

9. Mezidi M, Guérin C. Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients. Ann Transl Med. 2018;6(19). DOI: 10.21037/atm.2018.05.50
10. Elamoudy G, Mohammad SY, Abdellatif GA, Dessowky SM. Effect of Positioning on Oxygenation and Hemodynamics among Patients on Mechanical Ventilation. Evidence-Based Nursing Research. 2022;4(1):61- 67. DOI: 10.47104/ebnrojs3.v4i1.233
11. Yurdalan SU. Neonatlarda (Yeni Doğan) Pulmoner Rehabilitasyon. Bulletin of Thoracic Surgery 2015;6(1).
12. Doğan İE, Balcı, NÇ, Gündüz AG. Physiotherapy and Rehabilitation Approaches to Premature Infants in Neonatal Intensive Care Units. J PhyMed Rehab Stud Rep. 2022; (4), 150: 2-5. DOI: 10.47363/JPMRS/2021
13. Christian PS. Chest physiotherapy for infants. Int J Physiother Res. 2014;2(5):699-705. DOI: 10.3390/ijerph19106101
14. Bertone N. The role of physiotherapy in a neonatal intensive care unit. Australian journal of physiotherapy. 1988;34(1):27-34.
15. Clarke J, Geoghegan P, McEvoy N, Boylan M, Choileáin ON, Mulligan M, et al. Prone positioning improves oxygenation and lung recruitment in patients with SARS-CoV-2 acute respiratory distress syndrome; a single centre cohort study of 20 consecutive patients. BMC Res Notes. 2021;14(1):1-6. DOI: 10.1186/s13104-020-05426-2
16. Ripoll-Gallardo A, Grillenzoni L, Bollon J, Della Corte F, Barone-Adesi F. Prone positioning in non-intubated patients with COVID-19 outside of the intensive care unit: more evidence needed. Disaster Med
17. Liu X, Liu H, Liu S, Zhou W, Lan Q, Duan J, et al. Effects of Prone Positioning for Patients with Acute Respiratory Distress Syndrome Caused by Pulmonary Contusion: A Single-Center Retrospective Study. Canadian Respiratory Journal. 2022;4579030. DOI: 10.1155/2022/4579030
18. Reece-Anthony R, Lao G, Carter C, Notter J. COVID-19 disease: Acute respiratory distress syndrome and prone position. Clinics in Integrated Care. 2020;3:100024. DOI: 10.1016/j.intcar.2020.100024
19. Gattinoni L, Busana M, Giosa L, Macrì MM, Quintel M. Prone positioning in acute respiratory distress syndrome. Semin Respir Crit Care Med. 2019;40(01):094-100. DOI: 10.1055/s-0039-1685180
20. Cao Z, Yang Z, Liang Z, Cen Q, Zhang Z, Liang H, et al. Prone versus supine position ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. Emergency medicine international, 2020.
21. Langer T, Brioni M, Guzzardella A, Carlesso E, Cabrini L, Castelli G, et al. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Crit Care. 2021;25(1):1-11. DOI: 10.1186/s13054-021-03552-2
22. Ding L, Wang L, Ma W, He H. Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study. Crit Care. 2020;24(1):1-8. DOI: 10.1186/s13054-020-2738-5
23. Sud S, Sud M, Friedrich JO, Adhikari NK. Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. Cmaj. 2008;178(9):1153-1161. DOI: 10.1503/cmaj.071802
24. Mezidi M, Guérin C. Effect of body position and inclination in supine and prone position on respiratory mechanics in acute respiratory distress syndrome. Intensive Care Med. 2019;45(2):292-294. DOI: 10.1007/s00134-018-5493-1
25. Johnston C, Zanetti NM, Comaru T, Ribeiro SNDS, Andrade LBD, Santos SLLD. I Brazilian guidelines for respiratory physiotherapy in pediatric and neonatal intensive care units. Rev Bras Ter Intensiva. 2012;24:119-129. DOI: 10.1503/cmaj.071802
26. Rivas-Fernandez M. Roqué I Figuls M, Diez-Izquierdo A. Infant position in neonates receiving mechanical ventilation. Cochrane Database Syst Rev. 2016;11. DOI: 10.1002/14651858.CD003668.pub4
27. Lupton-Smith A, Argent, A, Rimensberger P, Frerichs I, Morrow B. Prone positioning improves ventilation homogeneity in children with acute respiratory distress syndrome. Pediatr Crit Care Med. 2017;18(5):229-234. DOI: 10.1097/PCC.0000000000001145
28. Bein T, Bischoff M, Brückner U, Gebhardt K, Henzler D, Hermes C, et al. S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders. Anaesthesist. 2015;64(1):1-26. DOI: 10.1007/s00101-015-0071-1
29. Onarıcı M, Karadağ M. Mekanik Ventilasyondaki Hastalarda Ventilatör İlişkili Pnömoniyi Önlemede Pozisyonun Önemi. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi. 2015;2(2):70-74.
30. Malhotra A, Kacmarek RM, Finlay GUWK. Prone ventilation for adult patients with acute respiratory distress syndrome. UpToDate®. Wolters Kluwers. 2020.
31. Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogué S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999;354(9193):1851-1858. DOI: 10.1016/S0140-6736(98)12251-1
32. Wang L, Li X, Yang Z, Tang X, Yuan Q, Deng L, et al. Semi‐recumbent position versus supine position for the prevention of ventilator‐associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst. Rev. 2016;(1). DOI: 10.1002/14651858. CD009946.pub2
33. Richard JCM, Maggiore SM, Mancebo J, Lemaire F, Jonson B, Brochard L. Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome. Intensive Care Med. 2006;32(10):1623-1626. DOI: 10.1007/s00134-006-0299-y
34. Keeley L. Reducing the risk of ventilator‐acquired pneumonia through head of bed elevation. Nurs Crit Care. 2007;12(6):287-294. DOI: 10.1111/j.1478-5153.2007.00247.x
35. Martinez BP, Marques TI, Santos DR, Silva VS, Nepomuceno BR, Alvesn GADA, et al. Influence of different degrees of head elevation on respiratory mechanics in mechanically ventilated patients. Rev Bras Ter Intensiva. 2015;27:347-352. DOI: 10.5935/0103-507X.20150059
36. Antunes LC, Rugolo LM, Crocci AJ. Effect of preterm infant position on weaning from mechanical ventilation. J Pediatr. 2003;79(3):239-44. DOI:10.1590/S0021-75572003000300010
37. Güçlü MB, Camcıoğlu B. Pediatrik kardiyak cerrahilerde pulmoner rehabilitasyon. Bulletin of Thoracic Surgery. 2015;6(1).
38. Katz S, Arish N, Rokach A, Zaltzman Y, Marcus EL. The effect of body position on pulmonary function: a systematic review. BMC Pulm Med. 2018;18(1):1-16. DOI: 10.1186/s12890-018-0723-4
39. Lizy C, Swinnen W, Labeau S, Poelaert J, Vogelaers D, Vandewoude K, et al. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Am J Crit Care. 2014;23(1):1-8. DOI: 10.4037/ajcc2014489
40. Manning F, Dean E, Ross J, Abboud RT. Effects of side lying on lung function in older individuals. Phys Ther. 1999;79(5):456-466. DOI:10.1093/ptj/79.5.456
41. Morrow BM. Chest Physiotherapy in the pediatric intensive care unit. J Pediatr Intensive Care. 2015;4(04):174-181. DOI: 10.1055/s-0035- 1563385
42. Gouna G, Rakza T, Kuissi E, Pennaforte T, Mur S, Storme L. Positioning effects on lung function and breathing pattern in premature newborns. J Pediatr. 2013;162(6):1133-1137. DOI: 10.1016/j.jpeds.2012.11.036
43. Staudinger T, Bojic A, Holzinger U, Meyer B, Rohwer M, Mallner F, et al. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia. Crit Care Med. 2010;38(2):486-490. DOI: 10.1097/ CCM.0b013e3181bc8218
44. Swadener-Culpepper L, Skaggs RL, VanGilder CA. The impact of continuous lateral rotation therapy in overall clinical and financial outcomes of critically ill patients. Crit Care Nurs Q. 2008;31(3):270-279. DOI: 10.1097/01.CNQ.0000325051.91473.42
45. Yurdalan SU. Yoğun bakım ünitelerinde güncel fizyoterapi yaklaşımları. Clinical and Experimental Health Sciences. 2011;1(3):196- 201.
46. Jelic S, Cunningham JA, Factor P. Clinical review: airway hygiene in the intensive care unit. Crit Care. 2008;12(2):1-9. DOI: 10.1186/cc6830
47. Kang SY, DiStefano MJ, Yehia F, Koszalka MV, Padula WV. Critical care beds with continuous lateral rotation therapy to prevent ventilator-associated pneumonia and hospital-acquired pressure injury: a cost-effectiveness analysis. J Patient Saf, 2021;17(2):149-155. DOI: 10.1097/ PTS.0000000000000582