Dott.

Ftr Angelo Longoni

Master in Fisioterapia e Riabilitazione Respiratoria

Variazione della ventilazione nei cambi posturali

Riabilitazione Specialistica Cardio-respiratoria e Neuromotoria Mariano Comense

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)

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

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 3 Flussimetro

2 MIP/MEP

4 Life Shirt

Posture utilizzate

60/70

90

120

140/150

SUPINO

La migliore di tre prove in tutte le posture

1 Spirometria

Curva flusso-volume
Normale

Restrittiva

Ostruttiva

1 S E R I E

2 S E R I E

2MIP

MEP

MEP
149 89

MIP
103 69

72

62 49 43

MEP
Fianco sx: 89 Fianco dx: 88

60 44

MIP
Fianco sx: 83 Fianco dx: 78

3 PEF

PEF

850 670
Fianco sx: 650 Fianco dx: 630

600 550 500

4 Life Shirt
(pletismografia induttiva cardio respiratoria)

ECG

Life Shirt

1 Respiro completo 2 3 Respiro addominale

Respiro toracico

Life Shirt

32484 ml

30579 ml

29203 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 95Supine Sitting on edge Stand WOS 1 min SOOB1 SOOB 20

VT (mls)

712.5 826.8 883.4 904.3 873.1 710.0 24.3 19.6 24.9 21.3 26.8 22.8 26.1 22.2 20.3 13.8

RR 21.4 b/pm VE l/min 15.1

GRAZIE DELL ATTENZIONE