POSIÇÃO CORPORAL E OXIGENAÇÃO PARTE I - PACIENTES COM DISFUNÇÃO PULMONAR UNILATERAL

Pimenta, Cibele Andrucioli de Mattos; Koizumi, Maria Sumie

doi:10.1590/0080-6234198902300300205

Resumos

Este estudo verificou o efeito das posições sentada, supina e laterais sobre os gases do sangue arterial, em pacientes com disfunção pulmonar unilateral, no pós-operatório recente de cirurgia cardíaca. Os gases sangüíneos foram mensurados após o paciente permanecer 15 minutos em cada posição. Concluiu-se que quando o paciente deitava-se sobre o lado do pulmão considerado sadio ou em supino, a Pa02 foi significativamente superior. No entanto, na posição deitada sobre o lado afetado, houve piora significativa da Pa02.

Gasometría — sangue; Posição corporal; Paciente, mudança de posição

The purpose of this study was to analyse the effects of sitting, supine and laterals positions on arterial oxygen tension (Pa02) and arterial carbon dioxide tension (PaC02), in 21 adults patients, carier of some pulmonary unilateral disfunction, in recent post-operative cardiac surgery. The diagnosis of the pulmonary disfunction was done through radiographic torax evaluation. The patients stayed during 15 minutes in each position and after this, the arterial blood gases were measured. Based on Friedman test and Multiple Comparation test (a = 0,05), it was found that the Pa02 was significantly higher when the patients were lying on the "healthy'' side or in supine position; the Pa02 was significantly lower when the patients where lying on the "sick" side. No significant changes in PaC02 were noted.

Blood gas analysis; Patient position; Patient, posture changes

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REFERÊNCIAS BIBLIOGRÁFICAS

ARBORELIUS, M. et alii. Influence of unilateral hypoxia on blood flow through the lungs in man in lateral position. J. Appl. Physiol., Bethesda, 15(4): 595-7, July 1960.
BIDIWALA, K. et alii. Lateral decubitus position and pulmonary interstitial emphysema. J. Pediatr., Saint Louis, 105(5): 847-88, Nov. 1984.
CONOVER, W.J. Practical nomparamentric statistics. 2. ed. New York, John Wiley, 1980. 300p.
DEAN, E. Effect of body position on pulmonary function. Phys. Ther., Washington, 65(5): 613-18, May 1985.
DHAINAUT, J.F. et alii. Improved oxygenation in patients with extensive unilateral pneumonia using the lateral decubitus position. Thorax, London, 35(10): 792-3, Oct 1980.
DICIONÁRIO Médico Blakiston. 2.ed. São Paulo, Andrei, 1982. 1169p.
DOUGLAS, W. W. et alii. Improved oxygenation in patients with acute respiratory failure: the prone position. Am. Rev. Respir. Dis., New York, 115(4): 559-66, Apr. 1977.
FROESE, A.B. & BRYAN, C. Effects of anesthesis and paralysis on diaphragmatic mechanics in man. Anyesthesiology, Philadelphia, 41(3): 242-55, Sept 1974.
GOODNOUGH, S.K.C. The effects of oxygen and hyperinflation on arterial oxygen tension after endotracheal suctioning. Heart Lung, Saint Louis, 14(1): 11-7, Jan. 1985.
GROSMAIRE, E.K. Use of patient positioning to improve Pa02: a review. Heart Lung, Saint Louis, 12(6): 650-3, Nov. 1983.
IB ANEZ, J. et alii. The effect of lateral positions on gas exchange in patients with unilateral lung disease during mechanical ventilation. Intensive Care Med., New York, 7(5): 231-5, Aug. 1981.
KAHN, A. et alii. Effects de la position ventrale sur les gas sanguins du nourrisson durant le sommeil. Arch. Fr. Pediatr., Paris, 42(6): 419-21, Juin/Juil. 1985.
KANEKO, K.J. et alii. Regional distribution of ventilation and perfusion as a function of body position. J. Appl. Physiol., Bethesda, 21(3): 767-77, May 1966.
KATZ, L.D. & BARASH, P.G. Positional hypoxaemia following post traumatic pulmonary insuddiciency. Can. Anaesth. Soc. J., Toronto, 24(3): 346-52, May 1977.
MARTI, C. & ULMER, W.T. Absence of effect of the body position on arterial blood gases. Respiration, Brasil, 43(1): 41-4, Jan./Feb. 1982.
NEAGLEY, R.S. & ZWILLICH, W.C. The effect of positional changes on oxigenation in patients with pleural effusions. Chest, Park Ridge, 88(5): 714-17, Nov. 1985.
NG, L. & McMCORMICK, K.A. Position changes and their physiological consequences. ANS, Germantown, 4(4): 13-25, July 1982.
NORTON, L.C. & CONFORTI, C.G. The effects of body position on oxygenation. Heart Lung, Saint Louis, 14(1): 45-52, Jan. 1985.
PEIRANO, P. et alii. Effect of sleep position on transcutaneous oxygen tension in SIDS siblings. Early Hum. Dev., Amsterdam, 13(3): 303-12, June 1986.
RAY, J.F. et alii. Immobility, hypoxaemia and pulmonary arteriovenous shunting. Arch. Surg., Chicago, 109(4): 537-41, Oct 1974.
RHEDER, K. et alii. The function of each lung of anesthetized and palyzed man during mechanical ventilation. Anesthesiology, Philadelphia, 37(1): 16-26, July 1972.
REMOLINA, C. et alii. Positional hypoxaemia in unilateral lung disease. N. Engl. J. Med., Boston, 304(9): 523-5, Feb. 1984.
SEATON, D. et alii. Effect of body position on gas exchange after thoracotomy. Thorax, London, 34(4):518-22, Aug. 1979.
WAGNER, P.D. & WEST, J.B. Changes in ventilation-perfusion relationships and gas exchange. In: MACKLEM, P. & PERMUTT, S. The lung in the transition between health and disease. New York, Marcel Dekker, 1979. cap.9, p. 183-226.
WEST, J.B. Fisiología respiratória moderna. São Paulo, Manole, 1977. p.26, 31 (a).
WEST, J.B. Ventilation perfusion relationships. Am. Rev. Respir. Dis., New York, 116(5): 919-43, Nov. 1977(b).
WEST, J.B. & DOLLERY, C.T. Distribution of blood flow and ventilation-perfusion ratio in the lung, measured with radioactive C02. J. Appl. Physiol., Bethesda, 15(3): 405-10,1960.
ZACK, B.M. et alii. The effect of lateral positions on gas exchange in pulmonary disease. Am. Rev. Respir. Dis., New York, 110(4): 49-55, Oct 1974.

Datas de Publicação

Publicação nesta coleção
Dez 1989

Histórico

Recebido
21 Nov 1988

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ARBORELIUS, M. et alii. Influence of unilateral hypoxia on blood flow through the lungs in man in lateral position. J. Appl. Physiol., Bethesda, 15(4): 595-7, July 1960.

[2] BIDIWALA, K. et alii. Lateral decubitus position and pulmonary interstitial emphysema. J. Pediatr., Saint Louis, 105(5): 847-88, Nov. 1984.

[3] CONOVER, W.J. Practical nomparamentric statistics. 2. ed. New York, John Wiley, 1980. 300p.

[4] DEAN, E. Effect of body position on pulmonary function. Phys. Ther., Washington, 65(5): 613-18, May 1985.

[5] DHAINAUT, J.F. et alii. Improved oxygenation in patients with extensive unilateral pneumonia using the lateral decubitus position. Thorax, London, 35(10): 792-3, Oct 1980.

[6] DICIONÁRIO Médico Blakiston. 2.ed. São Paulo, Andrei, 1982. 1169p.

[7] DOUGLAS, W. W. et alii. Improved oxygenation in patients with acute respiratory failure: the prone position. Am. Rev. Respir. Dis., New York, 115(4): 559-66, Apr. 1977.

[8] FROESE, A.B. & BRYAN, C. Effects of anesthesis and paralysis on diaphragmatic mechanics in man. Anyesthesiology, Philadelphia, 41(3): 242-55, Sept 1974.

[9] GOODNOUGH, S.K.C. The effects of oxygen and hyperinflation on arterial oxygen tension after endotracheal suctioning. Heart Lung, Saint Louis, 14(1): 11-7, Jan. 1985.

[10] GROSMAIRE, E.K. Use of patient positioning to improve Pa02: a review. Heart Lung, Saint Louis, 12(6): 650-3, Nov. 1983.

[11] IB ANEZ, J. et alii. The effect of lateral positions on gas exchange in patients with unilateral lung disease during mechanical ventilation. Intensive Care Med., New York, 7(5): 231-5, Aug. 1981.

[12] KAHN, A. et alii. Effects de la position ventrale sur les gas sanguins du nourrisson durant le sommeil. Arch. Fr. Pediatr., Paris, 42(6): 419-21, Juin/Juil. 1985.

[13] KANEKO, K.J. et alii. Regional distribution of ventilation and perfusion as a function of body position. J. Appl. Physiol., Bethesda, 21(3): 767-77, May 1966.

[14] KATZ, L.D. & BARASH, P.G. Positional hypoxaemia following post traumatic pulmonary insuddiciency. Can. Anaesth. Soc. J., Toronto, 24(3): 346-52, May 1977.

[15] MARTI, C. & ULMER, W.T. Absence of effect of the body position on arterial blood gases. Respiration, Brasil, 43(1): 41-4, Jan./Feb. 1982.

[16] NEAGLEY, R.S. & ZWILLICH, W.C. The effect of positional changes on oxigenation in patients with pleural effusions. Chest, Park Ridge, 88(5): 714-17, Nov. 1985.

[17] NG, L. & McMCORMICK, K.A. Position changes and their physiological consequences. ANS, Germantown, 4(4): 13-25, July 1982.

[18] NORTON, L.C. & CONFORTI, C.G. The effects of body position on oxygenation. Heart Lung, Saint Louis, 14(1): 45-52, Jan. 1985.

[19] PEIRANO, P. et alii. Effect of sleep position on transcutaneous oxygen tension in SIDS siblings. Early Hum. Dev., Amsterdam, 13(3): 303-12, June 1986.

[20] RAY, J.F. et alii. Immobility, hypoxaemia and pulmonary arteriovenous shunting. Arch. Surg., Chicago, 109(4): 537-41, Oct 1974.

[21] RHEDER, K. et alii. The function of each lung of anesthetized and palyzed man during mechanical ventilation. Anesthesiology, Philadelphia, 37(1): 16-26, July 1972.

[22] REMOLINA, C. et alii. Positional hypoxaemia in unilateral lung disease. N. Engl. J. Med., Boston, 304(9): 523-5, Feb. 1984.

[23] SEATON, D. et alii. Effect of body position on gas exchange after thoracotomy. Thorax, London, 34(4):518-22, Aug. 1979.

[24] WAGNER, P.D. & WEST, J.B. Changes in ventilation-perfusion relationships and gas exchange. In: MACKLEM, P. & PERMUTT, S. The lung in the transition between health and disease. New York, Marcel Dekker, 1979. cap.9, p. 183-226.

[25] WEST, J.B. Fisiología respiratória moderna. São Paulo, Manole, 1977. p.26, 31 (a).

[26] WEST, J.B. Ventilation perfusion relationships. Am. Rev. Respir. Dis., New York, 116(5): 919-43, Nov. 1977(b).

[27] WEST, J.B. & DOLLERY, C.T. Distribution of blood flow and ventilation-perfusion ratio in the lung, measured with radioactive C02. J. Appl. Physiol., Bethesda, 15(3): 405-10,1960.

[28] ZACK, B.M. et alii. The effect of lateral positions on gas exchange in pulmonary disease. Am. Rev. Respir. Dis., New York, 110(4): 49-55, Oct 1974.

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