Document Detail

The semi-seated position slightly reduces the effort to breathe during difficult weaning.
MedLine Citation:
PMID:  23093247     Owner:  NLM     Status:  Publisher    
PURPOSE: The influence of posture on breathing effort in patients with difficult weaning is unknown. We hypothesized that posture could modulate the breathing effort in difficult-to-wean patients. METHODS: A prospective, crossover, physiologic study was performed in 24 intubated patients breathing with pressure support who had already failed a spontaneous breathing trial or an extubation episode. Their median duration of mechanical ventilation before measurements was 25 days. Breathing pattern, occlusion pressure (P (0.1)), intrinsic PEEP (PEEP(i)), and inspiratory muscle effort evaluated by the pressure-time product of the respiratory muscles and the work of breathing were measured during three postures: the seated position in bed (90°LD), simulating the position in a chair, the semi-seated (45°), and the supine (0°) positions consecutively applied in a random order. A comfort score was obtained in 17 cooperative patients. The influence of position on chest wall compliance was measured in another group of 11 sedated patients. RESULTS: The 45° position was associated with the lowest levels of effort (p ≤ 0.01) and occlusion pressure (p < 0.05), and tended to be more often comfortable. Respiratory effort was the lowest at 45° in 18/24 patients. PEEP(i) and PEEP(i)-related work were slightly higher in the supine position (p ≤ 0.01), whereas respiratory effort, heart rate, and P (0.1) values were increased in the seated position (p < 0.05). CONCLUSION: A 45° position helps to unload the respiratory muscles, moderately reduces PEEP(i), and is often considered as comfortable. The semi-seated position may help the weaning process in ventilator-dependent patients.
N Deye; F Lellouche; S M Maggiore; S Taillé; A Demoule; E L'her; F Galia; A Harf; J Mancebo; L Brochard
Related Documents :
10526807 - Changes in respiratory pattern and arterial blood gases during sedation with propofol o...
15516347 - Bispectral index and a-line aai index as guidance for desflurane-remifentanil anaesthes...
7295447 - Controller anaesthesia: an approach using patient characteristics identified during upt...
25307237 - Effects of respiratory physiotherapy on intracranial pressure and cerebral perfusion pr...
17270757 - Assessment of emotional reaction induced by visual stimulation based on cross-correlati...
8694627 - A technique of positive-pressure single-lung ventilation via a silicone t-y stent.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-24
Journal Detail:
Title:  Intensive care medicine     Volume:  -     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Medical Intensive Care Unit (ICU), Henri Mondor University Hospital, AP-HP, Créteil, France,
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Intensive care unit environment may affect the course of delirium.
Next Document:  Copeptin as a marker of relative arginine vasopressin deficiency after pediatric cardiac surgery.