Call Girls Jayanagar Just Call 7001305949 Top Class Call Girl Service Available
Variazione della ventilazione nei cambi posturali. Dott. FtR Angelo Longoni
1. Dott. Ftr Angelo Longoni
Master in Fisioterapia e Riabilitazione Respiratoria
Variazione della
ventilazione
nei cambi posturali
Riabilitazione Specialistica Cardio-respiratoria e Neuromotoria
Mariano Comense
2. 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)
3. 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).
4. 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)
5. 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 dependent-
Gillespie et al)
“Bad lung up” position
6.
7. La FRC si riduce passando dalla posizione eretta (seduta) a
quella supina: la spinta del contenuto addominale sul diaframma
limita l’espansione del torace. Rappresenta il punto di equilibrio
tra fase in-espiratoria.
29. 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.
30. Zafiropoules et al (2004) Physiological responses
to the early mobilisation of the intubated,
ventilated absominal surgery patient. Aust. Journal
of Physiotherapy, 50, 95-100
95-
Supine Sitting Stand WOS SOOB1 SOOB
on 1 min 20
edge
VT 712.5 826.8 883.4 904.3 873.1 710.0
(mls)
RR 21.4 24.3 24.9 26.8 26.1 20.3
b/pm
VE 15.1 19.6 21.3 22.8 22.2 13.8
l/min