Effects of sitting position on ventilation distribution determined by electrical impedance tomography in ventilated ARDS patients

IF 4.9 2区医学 Q1 NURSING Intensive and Critical Care Nursing Pub Date : 2024-08-07 DOI:10.1016/j.iccn.2024.103782

Xiaofeng Chen , Ruyang Xiong , Ming Zhang , Chunming Guan , Liwei Feng , Zhipeng Yao , Yue Li , Wenhua Liu , Ming Ye , Yunlong Li , Xuesong Jiang , Yonglin Tang , Hongliang Wang , Junbo Zheng

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Abstract

Objective

The study aimed to evaluate the improvements in pulmonary ventilation following a sitting position in ventilated ARDS patients using electrical impedance tomography.

Methodology

A total of 17 patients with ARDS under mechanical ventilation participated in this study, including 8 with moderate ARDS and 9 with severe ARDS. Each patient was initially placed in the supine position (S1), transitioned to sitting position (SP) for 30 min, and then returned to the supine position (S2). Patients were monitored for each period, with parameters recorded.

Main Outcome measures

The primary outcome included the spatial distribution parameters of EIT, regional of interest (ROI), end-expiratory lung impedance (ΔEELI), and parameters of respiratory mechanics.

Results

Compared to S1, the SP significantly altered the distribution in ROI1 (11.29 ± 4.70 vs 14.88 ± 5.00 %, p = 0.003) and ROI2 (35.59 ± 8.99 vs 44.65 ± 6.97 %, p ＜ 0.001), showing reductions, while ROI3 (39.71 ± 11.49 vs 33.06 ± 6.34 %, p = 0.009), ROI4 (13.35 ± 8.76 vs 7.24 ± 5.23 %, p ＜ 0.001), along with peak inspiratory pressure (29.24 ± 3.96 vs 27.71 ± 4.00 cmH₂O, p = 0.036), showed increases. ΔEELI decreased significantly ventrally (168.3 (40.33 – 189.5), p ＜ 0.0001) and increased significantly dorsally (461.7 (297.5 – 683.7), p ＜ 0.0001). The PaO₂/FiO₂ ratio saw significant improvement in S2 compared to S1 after 30 min in the seated position (108 (73 – 130) vs 96 (57 – 129) mmHg, p = 0.03).

Conclusions

The sitting position is associated with enhanced compliance, improved oxygenation, and more homogenous ventilation in patients with ventilated ARDS compared to the supine position.

Implications for Clinical Practice

It is important to know the impact of postural changes on patient pulmonary ventilation in order to standardize safe practices in critically ill patients. It may be helpful in the management among ventilated patients.

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坐姿对通过电阻抗断层扫描测定的 ARDS 通气分布的影响。

研究目的该研究旨在利用电阻抗断层扫描评估通气的 ARDS 患者在采取坐姿后肺通气的改善情况：共有 17 名接受机械通气的 ARDS 患者参与了这项研究，其中包括 8 名中度 ARDS 患者和 9 名重度 ARDS 患者。每位患者起初都采取仰卧位（S1），30 分钟后转为坐位（SP），然后恢复仰卧位（S2）。每个阶段都对患者进行监测，并记录参数：主要结果包括 EIT 空间分布参数、感兴趣区（ROI）、呼气末肺阻抗（ΔEELI）和呼吸力学参数：与 S1 相比，SP 显著改变了 ROI1（11.29 ± 4.70 vs 14.88 ± 5.00 %，p = 0.003）和 ROI2（35.59 ± 8.99 vs 44.65 ± 6.97 %，p ＜ 0.001）的分布，显示出减少，而 ROI3（39.71 ± 11.49 vs 33.06 ± 6.34 %，p = 0.009）、ROI4（13.35 ± 8.76 vs 7.24 ± 5.23 %，p ＜ 0.001）以及吸气峰压（29.24 ± 3.96 vs 27.71 ± 4.00 cmH2O，p = 0.036）均呈上升趋势。ΔEELI 向腹侧明显下降（168.3 (40.33 - 189.5)，p ＜ 0.0001），向背侧明显上升（461.7 (297.5 - 683.7)，p ＜ 0.0001）。坐位 30 分钟后，S2 的 PaO2/FiO2 比率比 S1 有明显改善（108 (73 - 130) vs 96 (57 - 129) mmHg, p = 0.03）：结论：与仰卧位相比，坐位与 ARDS 患者顺应性增强、氧合改善和通气更均匀有关：了解体位变化对患者肺通气的影响对于规范重症患者的安全操作非常重要。对临床实践的启示：了解体位变化对患者肺通气的影响对于规范重症患者的安全操作非常重要，它可能有助于通气患者的管理。

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来源期刊

Intensive and Critical Care Nursing NURSING-

CiteScore

6.30

自引率

15.10%

发文量

144

审稿时长

57 days

期刊介绍： The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects.