Variazione della ventilazione nei cambi posturali. Dott. FtR Angelo Longoni

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The description of different ventilation during postural change

The description of different ventilation during postural change

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  • 1. Dott. Ftr Angelo Longoni Master in Fisioterapia e Riabilitazione Respiratoria Variazione della ventilazionenei cambi posturaliRiabilitazione Specialistica Cardio-respiratoria e Neuromotoria Mariano Comense
  • 2. Physiological effects of PositioningOptimizes oxygen transport by improving V/QmismatchIncreases lung volumesReduces the work of breathingMinimizes the work of heartEnhances mucociliary clearance (postural drainage)
  • 3. PositioningPositioning restores ventilation to dependentlung regions more effectively than PEEP orlarge tidal volumes (Froese & Bryan, 1974).Positioning has a marked influence on gasexchange because of unevenly damaged lungs(Tobin, 1994).Side lying reduces lung densities in the uppermost lung (Brismar, 1985).
  • 4. Right side lying may be more beneficial forcardiac output than left side lying (Wong, 1998).Simply turning from supine to side lying canclear atelectasis from dependent regions(Brismar, 1985).Positioning affects lung volumeLung volume is related to the position of thediaphragmFRC decreases from standing to slumped sittingto supine (Macnaughton, 1995)
  • 5. Positioning affects compliance (Wahba et al foundthat work of breathing is 40% higher in supinethan in sitting)Positioning affects arterial oxygenation byimproving V/Q mismatch (V/Q is usuallymismatched if the affected lung is dependent-Gillespie et al)“Bad lung up” position
  • 6. La FRC si riduce passando dalla posizione eretta (seduta) aquella supina: la spinta del contenuto addominale sul diaframmalimita l’espansione del torace. Rappresenta il punto di equilibriotra fase in-espiratoria.
  • 7. Dispositivi utilizzati1 Spirometro 3 Flussimetro2 MIP/MEP 4 Life Shirt
  • 8. Posture utilizzate60/70° 90° 120° 140/150° SUPINO
  • 9. La migliore di tre prove in tutte le posture1 Spirometria
  • 10. Curva flusso-volume Normale Restrittiva Ostruttiva
  • 11. 1 2 3 4 5
  • 12. 1°SERIE2°SERIE
  • 13. 2MIP
  • 14. MEP
  • 15. MEP MIP 149 103 89 69 72 62 60 49 MIPMEPFianco sx: 89 Fianco sx: 83Fianco dx: 88 44 43 Fianco dx: 78
  • 16. 3 PEF
  • 17. PEF 850 670 Fianco sx: 650 Fianco dx: 630 600 550 500
  • 18. 4 Life Shirt(pletismografia induttiva cardio respiratoria) ECG
  • 19. Life Shirt 1Respiro completo 2 3 Respiro toracico Respiro addominale
  • 20. Life Shirt1 2 3 4 5
  • 21. 32484 ml 30579 ml29203 ml 32988 ml
  • 22. 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.
  • 23. Zafiropoules et al (2004) Physiological responsesto the early mobilisation of the intubated,ventilated absominal surgery patient. Aust. Journalof Physiotherapy, 50, 95-100 95- Supine Sitting Stand WOS SOOB1 SOOB on 1 min 20 edgeVT 712.5 826.8 883.4 904.3 873.1 710.0(mls)RR 21.4 24.3 24.9 26.8 26.1 20.3b/pmVE 15.1 19.6 21.3 22.8 22.2 13.8l/min
  • 24. GRAZIE DELL’ ATTENZIONE