Thomas Peter J, Paratz Jennifer D, Lipman Jeffrey, Stanton Warren R
Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Heart Lung. 2007 Jul-Aug;36(4):277-86. doi: 10.1016/j.hrtlng.2006.10.008.
To investigate the effect of 90 degrees lateral positioning on oxygenation, respiratory mechanics, and hemodynamics in ventilated intensive care patients.
Thirty-four subjects (mean age = 46.1 +/- 17.3 years) with no, unilateral, or bilateral pulmonary infiltrates on chest radiograph participated. Arterial blood gas, respiratory mechanic, and hemodynamic data were analyzed at the supine starting position (T0), then 30 minutes and 2 hours into the lateral turn (T30 and T120, respectively) and 30 minutes post return to the supine position (T150).
No difference was found in PaO(2)/FiO(2) due to positioning patients from supine to lateral (P = .15) regardless of the underlying lung pathology. Dynamic compliance decreased during lateral positioning, particularly in the subjects with no lung pathology (T0 = 56 +/- 18.6 > (T30 = 49.9 +/- 18; T120 = 49.2 +/- 17) L/cmH(2)0, P < .01) or unilateral lung pathology (T0 = 41.4 +/- 11.2 > (T30 = 36.6 +/- 8.8; T120 = 37.3 +/- 9.5) L/cmH(2)0, P < .01). Blood pressure and heart rate were unaffected, but cardiac index significantly increased at T30 (T0 = 3.7 +/- 1.2, T30 = 4.8 +/- 1.3 L/min/m(2), P < .01). While the incidence of adverse events was high (21%), they were primarily minor and transient.
In this heterogeneous population, lateral positioning had no beneficial effect on gas exchange. However, in ventilated patients who were hemodynamically stable, it was well tolerated and not associated with significant serious adverse events.
探讨90度侧卧位对重症监护病房机械通气患者氧合、呼吸力学和血流动力学的影响。
34例胸部X线片无肺部浸润、单侧或双侧肺部浸润的受试者（平均年龄=46.1±17.3岁）参与研究。在仰卧起始位（T0）、侧卧位转换后30分钟和2小时（分别为T30和T120）以及恢复仰卧位后30分钟（T150）分析动脉血气、呼吸力学和血流动力学数据。
无论潜在肺部病变如何，将患者从仰卧位转为侧卧位时，PaO₂/FiO₂无差异（P = 0.15）。侧卧位时动态顺应性降低，尤其是在无肺部病变的受试者中（T0 = 56±18.6＞（T30 = 49.9±18；T120 = 49.2±17）L/cmH₂O，P＜0.01）或单侧肺部病变的受试者中（T0 = 41.4±11.2＞（T30 = 36.6±8.8；T120 = 37.3±9.5）L/cmH₂O，P＜0.01）。血压和心率未受影响，但心脏指数在T30时显著升高（T0 = 3.7±1.2，T30 = 4.8±1.3 L/min/m²，P＜0.01）。虽然不良事件发生率较高（21%），但主要为轻微和短暂性事件。
在这个异质性人群中，侧卧位对气体交换无有益影响。然而，在血流动力学稳定的机械通气患者中，侧卧位耐受性良好，且未发生严重不良事件。
