Objectives: To compare the effect of semi-recumbent and sitting positions on gas exchange, respiratory mechanics and hemodynamics in patients weaning from mechanical ventilation.
Background: Upright positions are encouraged during rehabilitation of the critically ill but there effects have not been well described.
Methods: A prospective, randomized, cross-over trial was conducted. Subjects were passively mobilized from supine into a seated position (out of bed) and from supine to a semi-recumbent position (>45° backrest elevation in bed). Arterial blood gas (PaO2/FiO2, PaO2, SaO2, PaCO2 and A-a gradient), respiratory mechanics (VE,VT, RR, Cdyn, RR/VT) and hemodynamic measurements (HR, MABP) were collected in supine and at 5 min and 30 min after re-positioning.
Results: Thirty-four intubated and ventilated subjects were enrolled. The angle of backrest inclination in sitting (67 ± 5°) was greater than gained with semi-recumbent positioning (50 ± 5°, p < 0.001). There were no clinically important changes in arterial blood gas, respiratory mechanic or hemodynamic values due to either position.
Conclusions: Neither position resulted in significant changes in respiratory and hemodynamic parameters. Both positions can be applied safely in patients being weaned from ventilation.
Keywords: Intensive care; Posture; Respiratory mechanics; Semi-recumbent; Weaning.
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