背景:在呼吸衰竭患者中,将躯干倾斜度从半卧位调整为仰卧位,反之亦然,会严重影响呼吸生理学的许多方面,包括呼吸力学,氧合,呼气末肺容积,和通气效率。尽管观察到了这些影响,目前关于这种定位操作的临床证据有限.这项研究对接受机械通气的呼吸衰竭患者进行了范围审查,以评估躯干倾斜度对生理肺参数的影响。
方法:PubMed,科克伦,和Scopus数据库从2003年到2023年进行了系统搜索。
方法:躯干倾斜度的变化。
方法:本研究评估了四个领域:1)呼吸力学,2)通风分布,3)氧合,和4)通气效率。
结果:搜索三个数据库并删除重复项之后,筛选了220项研究。其中,详细评估了37个,和13个被包括在最终分析中,包括274名患者。所有选定的研究都是实验性的,并评估了呼吸力学,通风分布,氧合,和通气效率,主要在姿势改变后60分钟内。
结论:在急性呼吸衰竭患者中,从仰卧位过渡到半卧位会导致呼吸系统顺应性降低和气道驱动压力增加。此外,C-ARDS患者的通气效率有所改善,导致PaCO2水平降低。在少数患者中观察到氧合改善,仅在移至半卧位后表现出EELV增加的患者中观察到。因此,机械通气下呼吸衰竭患者必须准确报告躯干倾角。
BACKGROUND: Adjusting trunk inclination from a semi-recumbent position to a supine-flat position or vice versa in patients with respiratory failure significantly affects numerous aspects of respiratory physiology including respiratory mechanics, oxygenation, end-expiratory lung volume, and ventilatory efficiency. Despite these observed effects, the current clinical evidence regarding this positioning manoeuvre is limited. This study undertakes a scoping
review of patients with respiratory failure undergoing mechanical ventilation to assess the effect of trunk inclination on physiological lung parameters.
METHODS: The PubMed, Cochrane, and Scopus databases were systematically searched from 2003 to 2023.
METHODS: Changes in trunk inclination.
METHODS: Four domains were evaluated in this study: 1) respiratory mechanics, 2) ventilation distribution, 3) oxygenation, and 4) ventilatory efficiency.
RESULTS: After searching the three databases and removing duplicates, 220 studies were screened. Of these, 37 were assessed in detail, and 13 were included in the final analysis, comprising 274 patients. All selected studies were experimental, and assessed respiratory mechanics, ventilation distribution, oxygenation, and ventilatory efficiency, primarily within 60 min post postural change.
CONCLUSIONS: In patients with acute respiratory failure, transitioning from a supine to a semi-recumbent position leads to decreased respiratory system compliance and increased airway driving pressure. Additionally, C-ARDS patients experienced an improvement in ventilatory efficiency, which resulted in lower PaCO2 levels. Improvements in oxygenation were observed in a few patients and only in those who exhibited an increase in EELV upon moving to a semi-recumbent position. Therefore, the trunk inclination angle must be accurately reported in patients with respiratory failure under mechanical ventilation.