Pulmonary function and posture in traumatic quadriplegia.

OBJECTIVE

To determine optimum posture for pulmonary function in traumatic quadriplegia.

DESIGN

Lung function with changes in posture of normal healthy volunteers was compared with that of traumatic quadriplegic patients.

MATERIALS AND METHODS

Functional residual capacity (FRC), Forced vital capacity (FVC), and arterial blood gases in room air were compared in 16 male patients aged 18 to 32 years, 8 of whom (group I) sustained traumatic quadriplegia (C6 to C7) at least 1 year previously, and 8 of whom (group II) were healthy volunteers.

MEASUREMENTS

FRC, FVC and blood gases were measured after 15 minutes in the following random positions: 20 degrees head down, horizontal, 35 degrees head up, 60 degrees head up, and 90 degrees head up.

MAIN RESULTS

FRC was lower in all positions in group I but there was a similar directional change in FRC with posture in both groups. The greatest increase in FRC occurred in group I between the 35-degree head up and the 60-degree head up positions. Group I, in contrast to group II, decreased FVC from the 35-degree head up to the 60-degree head up position. There were no significant changes in PO2 with position in group II, but quadriplegic patients showed PO2 improvement from the head down to the horizontal and 60-degree head up positions.

CONCLUSIONS

In traumatic quadriplegia, maximum oxygenation and patency of alveoli (FRC) are achieved in the 60- to 90-degree head up positions. In contrast to normal subjects, no changes in FRC and FVC occurred between the horizontal and 35-degree head up positions in quadriplegia. The optimum position in these patients for physiotherapy (deep breathing and coughing, as reflected by maximum FVC) is the horizontal or 35-degree head up position. These differences in lung volumes and oxygenation with posture may be important in optimizing respiratory care in traumatic quadriplegia.