Variazione della ventilazione nei cambi posturali. Dott. FtR Angelo Longoni
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The description of different ventilation during postural change
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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
- 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.
- 8. Dispositivi utilizzati 1 Spirometro 3 Flussimetro 2 MIP/MEP 4 Life Shirt
- 9. Posture utilizzate 60/70° 90° 120° 140/150° SUPINO
- 10. La migliore di tre prove in tutte le posture 1 Spirometria
- 12. Curva flusso-volume Normale Restrittiva Ostruttiva
- 13. 1 2 3 4 5
- 15. 2MIP
- 16. MEP
- 17. MEP MIP 149 103 89 69 72 62 60 49 MIP MEP Fianco sx: 89 Fianco sx: 83 Fianco dx: 88 44 43 Fianco dx: 78
- 18. 3 PEF
- 20. PEF 850 670 Fianco sx: 650 Fianco dx: 630 600 550 500
- 21. 4 Life Shirt (pletismografia induttiva cardio respiratoria) ECG
- 22. Life Shirt 1 Respiro completo 2 3 Respiro toracico Respiro addominale
- 23. Life Shirt 1 2 3 4 5
- 25. 32484 ml 30579 ml 29203 ml 32988 ml
- 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