Critical Illness Clinical Trial
Official title:
Effects of Positional Therapy on Pulmonary Physiology in Patients Undergoing Mechanical Ventilation.
The aim of this project is to evaluate the effects of positional changes in mechanically ventilated patients.
In critically ill patients undergoing invasive mechanical ventilation (IMV), several negative
effects converge, promoting the development of collapse in the dorsal areas of the lung.
These among others include deep sedation, relaxation, prolonged immobility and the supine
position. This results of an added impairment in lung function both in the mechanical and gas
exchange. In addition lung collapse contributes to a significant increase in the
heterogeneity the distribution of alveolar ventilation and perfusion that may increase the
risk of ventilator-induced lung injury (VILI).
Postural therapy is widely recommended as prevention/treatment of pressure ulcers, whose
presence, according to the Spanish Society of Intensive Care Medicine (SEMICYUC), is a
quality criterion for intensive care units (ICUs), with a prevalence of 18% in these units
compared to 7.8% in adult hospitalization. However, how postural changes may affect lung
function is an aspect that has been scarcely studied. Given the strong influence of gravity
on lung function, positional changes can produce significant alterations in the distribution
of trans-pulmonary pressures (a decrease along the vertical gravitational axis of
approximately 0.25 cmH2O per cm). Depending on the severity, distribution and location of the
respiratory pathology, positional changes may have a significant effect either benefiting or
impairing the patient's condition.
The investigators will dynamically assess the effects of routine lateral positioning up to
30-40º by means of electrical impedance tomography (EIT), a non-invasive, radiation-free
functional bedside imaging technique that allows to monitor the regional distribution of
ventilation and perfusion.
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