EFFECT OF POSITION CHANGE ON OXYGENATION AND RESPIRATORY MECHANICS IN MECHANICALLY VENTILATED PATIENTS WITH RESPIRATORY PROBLEMS

تأثيرتغيير الوضع على الأكسجة و آليات التنفس عند مرضى التنفس الآلي الذين يعانون من مشاكل تنفسية

Body positioning is one of the general kinds of nursing actions during care of patients. Critically ill patients positioning maximizes ventilation to improve oxygenation which in turn would affect the individual’s ability to maintain an internal environment that allows normal cellular function The critical care nurse plays a crucial role in the assessment, diagnosis, and management of patients with respiratory problems who develop hypoxemia.

واضعي السياسات الصحية تشكيل رأي عام

Studies related to the adequate duration in each position and the frequency of turning patients for maximizing ventilation to improve systemic oxygenation has not been attempted. The importance of the effect of body position on ventilatory function and gas exchange has been appreciated. Less information is available concerning the effect of position change on gas exchange in human body.

To determine the effect of position change on oxygenation and respiratory mechanics in patients with respiratory problems. To determine the effect of position change on oxygenation and respiratory mechanics in patients with respiratory problems.

MATERIAL Setting Critical care units of the Main University Hospital in Alexandria.

Subjects Adult patients with respiratory problems receiving mechanical ventilatory support were studied Intern nurses were trained to help the researcher in turning patients, four at a time 30 48

Patients excluded from the study Low Lowhemoglobin Arrhythmi a Facial surgery Skeletaldeformity Head or spine injury obesity Abdominal distension distension Carbon monoxide poisoning, pulmonary hemorrhage, pulmonary hemorrhage, pulmonary abscess. hyperthermia

Socio-economic assessment sheet Position record Assessmen t sheet Tools *Knowledge assessment sheet *observation sheet

METHODS *HD, ABG, RM were evaluated immediately before and every half-hour after turning patient for a total of 6 hours for each patient *Patients were turned to left, prone, right, supine position respectively * Researcher trained nurses to help in patient turning * Instructions were given about how to turn the ventilated patients in the proper way Nurses’ instructions Patients positioning

Dependent variables hemodynamics arterial blood gases and respiratory mechanics were assessed. Four groups of patients were used in this experimental study Independent variables of position were altered as each patient was moved from the supine, to left lateral, prone,and right lateral position. The effect of this movement on the

#General characteristics of the study sample #General characteristics of the study sample #Effects of turning on Resultswere Oxygenation Respiratory mechanics

Distribution of patients by age

Distribution of patients by sex

Distribution of patients by socio- economic level

Position change and hemodynamic B.L.P=Base line positionL.L.P=Left lateral position P.P= Prone positionR.L.P=Right lateral position S.P= Supine position

Position change and respiratory mechanics B.L.P=Base line positionL..L.P= Left lateral position P.P= Prone positionR.L.P= Right lateral position S.P= Supine position

Position change and arterial blood gases B.L.P=base line positionL.L.P=Left lateral position P.P=Prone position R.L.P=Right lateral position S.P=Supine position

Differences in PaO2 in patients with normal lungs according to time and position t-test significant > 2.3

Differences in PaO2 in patients with bilateral lung disease according to time and position t-test significant > 2.3

Differences in PaO2 in patients with right lung disease according to time and position t-test significant > 3.2

Differences in PaO2 in patients with left lung disease according to time and position t-test significant > 2.6

Differences in hypoxemic oxygen index (PaO2/FIo2) in patients with normal lungs according to time and position t-test significant > 2.3

Differences in hypoxemic oxygen index (PaO2/FIo2) in patients with bilateral lung disease according to time and position t-test significant > 2.3

Differences in hypoxemic oxygen index (PaO2/FIo2) in patients with right lung disease according to time and position t-test significant > 3.2

Differences in hypoxemic oxygen index (PaO2/FIo2) in patients with left lung disease according to time and position t-test significant > 2.6

position changes had a significant effect on oxygenation in mechanically ventilated patients A hierarchy of body positioning alternatives is based on the physiologic justification of the various positions. These positions range from the most to the least physiologic.

The improvement in arterial blood gases depends on site and extent of lung pathology Normal lungs lungs Bilateral disease disease Unilateraldisease ABG are improved in all positions The best position is prone The subsequent are right and then left The subsequent are right and then left The same improvement in duration and frequency but less than in normal lung Are improved with the good lung down Are improved with the good lung down Are worsened with the affected lung down Are worsened with the affected lung down

In both Healthy lungs Diseased lungs Prone and side lying positions enhance the efficiency of O 2 transport and thereby minimize or avoid use of high concentration of supplemental oxygen and positive end expiratory pressure.

body positioning is a 24-hours concern For any critically ill patient

Patients with normal lungs and patients with bilateral lung disease Tur n Left 1.5 hr Prone 1.5 hr Right 1.5 hr Supine 1.5 hr

Patients with right lateral lung disease Turn Left 1.5 hr Prone 1.5 hr Right 0.5hr Supine 1.5 hr

patients with left lateral lung disease Tur n Prone 1.5 hr Right 1.5 hr Supine 1.5 hr No left

Position change is asimple way to reduce shunting and improve oxygenation Position change is a simple way to reduce shunting and improve oxygenation It allows reduction in FIO 2 and PEEP and reducing their complications *do your patients a good turn *Try the position changes early in the course of illness Turning a critically ill patients is not difficult. It requires four trained nurses

More studies are needed to evaluate Using larger sample Frequentcycles using different duration Steep position Other range of positions

Hospital administration Schools of nursing Critical care units *pre-service training programs (for newly critical care nurses) *in-service training programs (for already critical care nurses) *pre-service training programs (for newly critical care nurses) *in-service training programs (for already critical care nurses) Books and scientific magazines The care of critically ill patients in their programs

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