| Effects of extreme lateral posture on hemodynamics and plasma atrial natriuretic peptide levels in critically ill patients. | |
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MedLine Citation:
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PMID: 8844229 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To quantify the hemodynamic effects of turning critically ill, mechanically ventilated patients to the extreme left and right lateral postures. DESIGN: Prospective investigation. SETTING: Eight-bed intensive care unit in a university hospital. PATIENTS: Twelve consecutive patients presenting with severe respiratory failure and requiring continuous positive inotropic support. INTERVENTIONS: All patients were mechanically ventilated and placed in a kinetic treatment system. They were positioned in the supine, left dependent, and right dependent postures, resting for 15 min in each position. MEASUREMENTS AND RESULTS: Hemodynamic measurements, assessments of right ventricular function, and determinations of intrathoracic blood volume were performed in three different positions. Concentrations of atrial natriuretic peptide in plasma were quantified. In three patients, the findings were controlled by transesophageal echocardiography. Cardiac index [median (range) 5.5 (3.2-8.1) vs 4.3 (3.2-7.5) l/min per m2, p < 0.01], intrathoracic blood volume [1125 (820-1394) vs 1037 (821-1267) ml/m2, p < 0.01], and right ventricular end-diastolic volume [130 (83-159) vs 114 (79-155) ml/m2, p < 0.05] increased significantly in the left dependent position compared to supine. Mean arterial pressure did not change. Atrial natriuretic peptide levels rose from 140 to 203 pg/ml. In the right dependent position, we found a marked decrease in the mean arterial pressure [85 mmHg (supine) to 72 mmHg (right dependent), p < 0.01]. Cardiac index and intrathoracic blood volume were unchanged, but right ventricular end-diastolic volume decreased from 114 to 102 ml/m2 (p < 0.05). Additionally, atrial natriuretic peptide levels decreased significantly (median delta value: 37 pg/ml). In echocardiographic controls we found an increase in right ventricular end-diastolic diameters in the left dependent position and shortened diameters in the right dependent position. CONCLUSIONS: Extreme lateral posture affects the cardiovascular system in critically ill, mechanically ventilated patients: in the left dependent position a "hyperdynamic state" is reinforced, while the right decubitus position impairs right ventricular preload and predisposes to hypotension. Echocardiography and changes in plasma atrial natriuretic peptide values indicate that these findings are due to altered distensibility of the right ventricle caused by regional intrathoracic gravitational changes. We conclude that the duration and the angle of lateral posture should be restricted in hemodynamically unstable patients. |
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Authors:
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T Bein; C Metz; C Keyl; M Pfeifer; K Taeger |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Intensive care medicine Volume: 22 ISSN: 0342-4642 ISO Abbreviation: Intensive Care Med Publication Date: 1996 Jul |
Date Detail:
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Created Date: 1996-12-20 Completed Date: 1996-12-20 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 651-5 Citation Subset: IM |
Affiliation:
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Department of Anesthesia, University Hospital, University of Regensburg, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Atrial Natriuretic Factor / blood* Critical Illness Echocardiography, Transesophageal Female Hemodynamics* Humans Male Middle Aged Monitoring, Physiologic Posture* Prospective Studies Respiration, Artificial Respiratory Insufficiency / blood, physiopathology*, ultrasonography |
| Chemical | |
Reg. No./Substance:
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85637-73-6/Atrial Natriuretic Factor |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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