Bein, Thomas (2008) Positioning in prophylaxis or therapy of pulmonary disorders S2e-guideline of the German society of anaesthesiology and intensive care medicine. ANASTHESIOLOGIE & INTENSIVMEDIZIN, 49 (Suppl1). S1-S24. ISSN 0170-5334, 1439-0256
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Following a mandate of the,German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin, DGAI)", a guideline on positioning therapy was produced by an expert group on the basis of the principles of evidence-based medicine. The statements were consented by the technique of a nominal process. The reference search was performed by Pubmed/Medline, Embase and Cochrane. 287 out of 379 references were identified and valued according to criteria of the Oxford Centre for Evidence-Based Medicine. Recommendations' for the use of prone position (PP), continuous lateral rotational therapy (CLRT), lateral position and semi-recumbent position were given. Recommendation levels (RL) were classified in terms of A, B and O. Patients on mechanical ventilation should be placed on semirecumbent position (45 degrees) to prevent ventilator-associated pneumonia (VAP) or a pulmonary aspiration of gastric content (RL A). For patients suffering from severe acute respiratory distress syndrome (ARDS) with life-threatening hypoxemia (PaO2/FIO2 < 100), PP is recommended for at least 12 hours to improve the pulmonary gas exchange. CLRT should be applied in case PP is contraindicated (acute shock syndrome or severe cardiac arrhythmia, acute brain injury without intracranial pressure monitoring, open abdomen, instability of column). PP and CLRT might be useful positions in cases of non-life threatening hypoxemia (RL 0). A positive influence on the survival rate of patients due to PP or CLRT has not been demonstrated yet. PP (RL B) and CLRT (RL 0) are suitable to prevent VAP. In patients with unilateral lung disease the technique of lateral position ("good lung down") is recommended (RL B). Basically, all techniques applied in positioning therapy should be applied proficiently by a well-trained team.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | RESPIRATORY-DISTRESS-SYNDROME; ACUTE LUNG INJURY; MECHANICALLY VENTILATED PATIENTS; CRITICALLY-ILL PATIENTS; INHALED NITRIC-OXIDE; END-EXPIRATORY PRESSURE; CEREBRAL PERFUSION-PRESSURE; LATERAL ROTATIONAL THERAPY; FREQUENCY OSCILLATORY VENTILATION; RANDOMIZED CONTROLLED-TRIAL; prone position; continuous axial rotational therapy; semirecumbent position; lateral position; acute lung failure |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 12 Jan 2021 16:55 |
| Last Modified: | 12 Jan 2021 16:55 |
| URI: | https://pred.uni-regensburg.de/id/eprint/31387 |
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