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Angelo Longoni Variazione Della Ventilazione Nei Cambi Posturali
Angelo Longoni Variazione Della Ventilazione Nei Cambi Posturali
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).
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)
La FRC si riduce passando dalla posizione eretta (seduta) a quella supina: la spinta del contenuto addominale sul diaframma limita lespansione del torace. Rappresenta il punto di equilibrio tra fase in-espiratoria.
Dispositivi utilizzati
1 Spirometro 3 Flussimetro
2 MIP/MEP
4 Life Shirt
Posture utilizzate
60/70
90
120
140/150
SUPINO
1 Spirometria
Curva flusso-volume
Normale
Restrittiva
Ostruttiva
1 S E R I E
2 S E R I E
2MIP
MEP
MEP
149 89
MIP
103 69
72
62 49 43
MEP
Fianco sx: 89 Fianco dx: 88
60 44
MIP
Fianco sx: 83 Fianco dx: 78
3 PEF
PEF
850 670
Fianco sx: 650 Fianco dx: 630
4 Life Shirt
(pletismografia induttiva cardio respiratoria)
ECG
Life Shirt
Respiro toracico
Life Shirt
32484 ml
30579 ml
29203 ml
32988 ml
Zafiropoules et al (2004) Physiological responses to the early mobilisation of the intubated, ventilated absominal surgery patient. Aust. Journal of Physiotherapy, 50, 95-100 95Supine Sitting on edge Stand WOS 1 min SOOB1 SOOB 20
VT (mls)
712.5 826.8 883.4 904.3 873.1 710.0 24.3 19.6 24.9 21.3 26.8 22.8 26.1 22.2 20.3 13.8