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Total Lift Bed Pulmonary

Upright positioning allows for improved lung volumes and alveolar recruitment through gravity assisted offloading of abdominal contents off the diaphragm. Additionally, the heart is positioned more anteriorly in the chest offloading the left lower lobe, which is compressed in supine.

 

During verticalization, there is improved ventilation-perfusion (V/Q) matching through a more homogenous pressure gradient in upright position due to repositioning of fluid. This helps to improve the arterial partial pressure of oxygen (PaO2) compared to the concentration of oxygen inspired or delivered (FiO2) or improved P/F ratio. 

Pulmonary

VitalGo Animation

VitalGo Animation

Dr Bouchant Study explanation

Dr Bouchant Study explanation

Study 

Physiological Effects and Safety of Bed Verticalization in Patients with Acute Respiratory Distress Syndrome

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 Protocol

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  1.  Pulmonary Resources:

  2. Yamada Y, Yamada M, Chubachi S, et al. Comparison of inspiratory and expiratory lung and lobe volumes among supine, standing, and sitting positions using conventional and upright CT. Scientific Reports 2020; 10: 16203. https://doi.org/10.1038/s41598-020-73240-8

  3. Bouchant L, Audard J, Arpajou G, et al. Physiological Effects and Safety of Bed Verticalization in Patients with Acute Respiratory Distress Syndrome; Am J Respir Crit Care Med; 2022;205:A5033

  4. Richard JM, Maggiore SM, Mancebo J, Lemaire F, Jonson B, Brochard L. Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome. Intensive Care Med 2006; 32:1623-1626. doi: 10.1007/s00134-006-0299-y

  5. Zhu M, Zhang W, Wang J, et al. Upright position mechanical ventilation: An alternative strategy for ALI/ARDS patients?. Medical Hypotheses 2009; 73:821-823. doi:10.1016/j.mehy.2009.03.023

  6. Hoste EA, Roosens CD, Bracke S, et al. Acute Effects of Upright Position on Gas Exchange in Patients With Acute Respiratory Distress Syndrome. J Intensive Care Med 2005; 20:43-49. doi: 10.1177/0885066604271616

  7. Mezidi M, Guérin C. Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients. Ann Transl Med 2018; 6(19)384. doi: 10.21037/atm.2018.05.50

  8. Martinez BP, Marques TI, Santos DR, et al. Influence of different degrees of head elevation on respiratory mechanics in mechanically ventilated patients. Rev Bras Ter Intensiva 2015; 27(4): 347-352. Doi: 10.5935/0103-507X.20150059

  9. Hickman CE, Montecinos-Munoz NR, Castanares-Zapatero D, et al. Acute Effects of Sitting Out of Bed and Exercise on Lung Aeration and Oxygenation in Critically Ill Subjects. Respir Care 2021; 66(2): 253-262. doi: 10.4187/respcare.07487

  10. Sonpeayung R, Tantisuwat A, Janwantanakul P, Thaveeratitham P. Total and Compartmental Chest Wall Volumes, Lung Function, and Respiratory Muscle Strength in Individuals with Abdominal Obesity: Effects of Body Positions. J Obesity; 2019; 3:1-10. doi:10.1155/2019/9539846

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