POSITION CHANGES : POSITION CHANGES : FREQUENCY AND FREQUENCY AND
DURATIONDURATION
Position change is one of the general kinds of Position change is one of the general kinds of nursing actions during care of patients.nursing actions during care of patients.
Critically ill patients positioning maximizes Critically ill patients positioning maximizes ventilation to improve oxygenation which in ventilation to improve oxygenation which in turn would affect the individual’s ability to turn would affect the individual’s ability to maintain an internal environment that allows maintain an internal environment that allows normal cellular function normal cellular function
The critical care nurse plays a crucial role in the The critical care nurse plays a crucial role in the assessment, diagnosis, and management of assessment, diagnosis, and management of
patients with respiratory problems who develop patients with respiratory problems who develop hypoxemia. hypoxemia.
Studies related to the adequate duration in each Studies related to the adequate duration in each position and the frequency of turning patients position and the frequency of turning patients for maximizing ventilation to improve systemic for maximizing ventilation to improve systemic
oxygenation has not been attemptedoxygenation has not been attempted
The importance of The importance of the effect of body the effect of body position on position on ventilatory ventilatory function and gas function and gas exchange has been exchange has been appreciatedappreciated
Less information is Less information is available available concerning the concerning the effect of position effect of position changes on gas changes on gas exchange in human exchange in human body body
To determine the effect of To determine the effect of position changes on position changes on oxygenation and respiratory oxygenation and respiratory mechanics in mechanically mechanics in mechanically ventilated patientsventilated patients
position changes had a significant effect on
oxygenation in mechanically ventilated patients
The improvement in arterial blood gases depends The improvement in arterial blood gases depends on site and extent of lung pathologyon site and extent of lung pathology
NormalNormal
lungslungs
BilateralBilateral
diseasedisease
UnilateralUnilateral
diseasedisease
ABG are improved in all positions ABG are improved in all positions
The best position is prone The best position is prone
The subsequent are right and then leftThe subsequent are right and then left
The same improvement in duration andThe same improvement in duration and
frequency but less than in normal lungfrequency but less than in normal lung
Are improved with the good lung down Are improved with the good lung down
Are worsened with the affected lung downAre worsened with the affected lung down
In bothIn both
Healthy
lungs
Diseased lungs
Prone and side lying positions enhance
the efficiency of O2 transport
and thereby minimize or avoid use of high
concentration of supplemental oxygen
and positive end expiratory pressure.
body positioning isbody positioning is
a 24-hours concerna 24-hours concern
For any For any critically ill critically ill
patientpatient
Patients with normal Patients with normal lungs and patients with lungs and patients with bilateral lung diseasebilateral lung disease
Turn
Left
1.5 hr
Prone
1.5 hrRight
1.5 hr Supine
1.5 hr
Patients with right lung Patients with right lung diseasedisease
Turn
Left
1.5 hr
Prone
1.5 hr Right
0.5hr
Supine
1.5 hr
patients with left lung patients with left lung diseasedisease
Turn
Prone
1.5 hr Right
1.5 hr Supine
1.5 hr
No left
Position change is aPosition change is a simple simple way to reduce shunting and way to reduce shunting and improve oxygenation improve oxygenation
It allows reduction in FIOIt allows reduction in FIO2 2
and PEEP and reducing their and PEEP and reducing their complicationscomplications
*do your patients
a good turn
*Try the position
changes early in
the course of
illness
*do your patients
a good turn
*Try the position
changes early in
the course of
illness Turning a critically ill Turning a critically ill patients is not difficult. It patients is not difficult. It requires four trained nursesrequires four trained nurses
Hospital
administration
Schools of
nursing
CriticalCritical
care unitscare units
*pre-service*pre-service training training programs (for newly critical programs (for newly critical
care nurses)care nurses)*in-service*in-service training programs training programs
(for already critical care (for already critical care nurses) nurses)
Books and scientific Books and scientific magazinesmagazines
The care of critically ill The care of critically ill patients in their programspatients in their programs
TurnTurn TurnTurn
TurnTurn TurnTurn