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Titolo:
The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury
Autore:
Davis, K; Johannigman, JA; Campbell, RS; Marraccini, A; Luchette, FA; Frame, SB; Branson, RD;
Indirizzi:
Univ Cincinnati, Dept Surg, Cincinnati, OH 45267 USA Univ Cincinnati Cincinnati OH USA 45267 pt Surg, Cincinnati, OH 45267 USA
Titolo Testata:
CRITICAL CARE
fascicolo: 2, volume: 5, anno: 2001,
pagine: 81 - 87
SICI:
1466-609X(2001)5:2<81:TAEOBP>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
CRITICALLY ILL PATIENTS; INTENSIVE-CARE UNIT; VENTILATION-PERFUSION RELATIONSHIPS; CHEST PHYSICAL THERAPY; PULMONARY COMPLICATIONS; DISTRESS-SYNDROME; PRONE POSITION; OUTCOMES; SURGERY; ARDS;
Keywords:
continuous lateral rotation; hypoxemia; mechanical ventilation; paralysis; positioning; secretion removal; sedation;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Davis, K Univ Cincinnati, Dept Surg, 231 Bethesda Ave, Cincinnati, OH 45267 USA Univ Cincinnati 231 Bethesda Ave Cincinnati OH USA 45267 5267 USA
Citazione:
K. Davis et al., "The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury", CRIT CARE, 5(2), 2001, pp. 81-87

Abstract

Background: Routine turning of critically ill patients is a standard of care, In recent years, specialized beds that provide automated turning have been introduced. These beds have been reported to improve lung function, reduce hospital-acquired pneumonia, and facilitate secretion removal. This trial was designed to measure the physiological effects of routine turning andrespiratory therapy in comparison with continuous lateral rotation (CLR). Methods: The study was a prospective, quasi-experimental, random assignment, trial with patients serving as their own controls. Paralyzed, sedated patients with acute respiratory distress syndrome were eligible for study. Patients were randomized to receive four turning and secretion management regimens in random sequence for 6 h each over a period of 24 h: (1) routine turning every 2 h from the left to right lateral position; (2) routine turning every 2 h from the left to right lateral position including a 15-min period of manual percussion and postural drainage (P&PD); (3) CLR with a specialized bed that turned patients from left to right lateral position, pausingat each position for 2 min; and (4) CLR with a specialized bed that turnedpatients from left to right lateral position pausing at each position for 2 min, and a 15-min period of percussion provided by the pneumatic cushionsof the bed every 2 h. Results: Nineteen patients were entered into the study. There were no statistically significant differences in the measured cardiorespiratory variables. There was a tendency for the ratio of partial pressure of arterial oxygen to fractional inspired oxygen concentration (PaO2/FIO2) to increase (174+/- 31 versus 188 +/- 36; P= 0.068) and for the ratio of deadspace to tidal volume (V-d/V-t) to decrease (0.62 +/- 0.18 versus 0.59 +/- 0.18; P= 0.19) during periods of CLR, but these differences did not achieve statistical significance. There were statistically significant increases in sputum volume during the periods of CLR. The addition of P&PD did not increase sputum volume for the group as a whole. However, in the four patients producing more than 40 mi of sputum per day, P&PD increased sputum volume significantly. The number of patient turns increased from one every 2 h to one every 10 min during CLR. Conclusion: The acute effects of CLR are undoubtedly different in other patient populations (spinal cord injury and unilateral lung injury). The linkbetween acute physiological changes and improved outcomes associated with CLR remain to be determined.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 26/01/20 alle ore 22:47:19