A Comparison of Effect of Semi Fowler's and Side Lying Position on Pulmonary Functions and Oxygen Saturation in Bedridden Patients
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
International Journal of Health Sciences and Research
DOI: https://doi.org/10.52403/ijhsr.20210507
Vol.11; Issue: 5; May 2021
Website: www.ijhsr.org
Original Research Article ISSN: 2249-9571
A Comparison of Effect of Semi Fowler’s and Side
Lying Position on Pulmonary Functions and Oxygen
Saturation in Bedridden Patients
Pooja Patel1, Sweety Shah2
1
Post-Graduate Student, SBB College of Physiotherapy, VSGH Hospital, Ahmedabad, Gujarat.
2
Ph.D. MPT, SBB College of Physiotherapy, VSGH Hospital, Ahmedabad, Gujarat.
Corresponding Author: Pooja Patel
ABSTRACT
Background: Body positioning is prescribed to optimize cardiopulmonary functions. Positioning
helps to improve lung function and oxygen saturation in patients who are bedridden for longer
duration. The aim of the present study is comparing semi fowler’s position to side lying position (right
and left side lying).
Method: Thirty bedridden subjects who were haemodynamically stable were included in the study.
Out of them three groups were made in which first group was given semi fowler’s position, second
group was given left side lying and third group was given right side lying position. Patients have to
maintain this position for 30 minutes.
Outcome measure: FVC, FEV1, RR and SPO2 were taken before and after positioning which are
objective measure of lung function and oxygen saturation respectively. Parameters were compared
before and after positioning and between groups by non-parametric tests.
Result: shows significant difference between before and after within groups. When each of these
sides lying position were compared to semi fowler’s positions, semi fowler’s position was found to be
more effective in improving pulmonary functions and oxygen saturation.
Keywords: Semi Fowler’s, Side Lying, Positioning, Pulmonary Functions, Oxygen Saturation.
INTRODUCTION position is a variant of upright position in
Therapeutic body positioning is which head of bed is elevated to 30 to 45
different from routine body positioning degrees [2]. The side lying position is
which is prescribed to optimize preferred more than the supine position for
cardiopulmonary function and oxygen bedridden patients. Side lying position
transport in bedridden subjects. Body attenuated anterior-posterior expansion of
position stimulates normal physiological transverse excursion of the dependent chest
effect of gravity and position change wall. FVC is maximum volume of air that
in oxygen transport and lung volume. [1] can be exhaled out of the lung as forcefully
This is very important in bed ridden as possible following maximum inspiration.
patients. The distribution of ventilation and Patients were asked to sit on bedside with
perfusion & V/Q mismatch in the lungs are support and take deep inspiration. A clip is
influenced primarily by gravity and placed over patients nose and patients
therefore also by body positioning. exhales forcefully for 6 sec in mouthpiece
Manipulating body position can alter by sealing their lips tightly over the
determinants of ventilation, perfusion and mouthpiece. FEV1 measures volume of air
pulmonary functions. Semi fowler’s exhaled in first second of FVC [3]. Normal
International Journal of Health Sciences and Research (www.ijhsr.org) 53
Vol.11; Issue: 5; May 2021Pooja Patel et.al. A comparison of effect of semi fowler’s and side lying position on pulmonary functions and
oxygen saturation in bedridden patients.
individuals can exhale 75% of vital capacity therapeutic positioning patient should be in
in first second of exhalation. SpO2 was supine position two hours priorly to
measured with pulse oximeter. The infrared eliminate bias in results.
sensor of a pulse oximeter worn on the Portable spirometer was used to
finger, toes or earlobe which detects amount measure FVC, FEV1. Oxygen saturation
of oxygen saturating haemoglobin by was measured by pulse oximeter and RR
interpreting the density of the blood flow was measured manually. Initially patient
through the body part with the probe. was given supine position and parameters
Respiratory rate was measured per minute before giving positioning were recorded.
[4]
. Semi fowler’s positions was given to patient
The need of present study is to be lifting the bed on head side up to 45
provide insight about short term effect of degrees. Side lying was achieved by turning
positioning on pulmonary functions and patient to left and right supine side lying.
provide baseline for rehabilitation of Side lying was obtained by drawing the
bedridden patients. So the aim of present imaginary line from head of the humerus at
study is to see effects of semi fowler’s an angle to the horizontal to obtain a 90
positioning and side lying positions on degree angle. Head supported by pillow,
pulmonary functions and oxygen saturation both arms will be fixed anteriorly and
in hemodynamically stable bedridden pillow was inserted between knees. Patients
patients. maintained these positioning and parameters
were collected after 30 minutes.
MATERIALS AND METHODOLOGY
Procedure: STATISTICAL ANALYSIS
Observational study design was used This study was conducted to
to compare effects of positioning between compare semi fowler’s position with any of
semi fowler’s and side lying positions. 30 the side lying position in bedridden patients
patients were included in the study. for measuring pulmonary functions and
Inclusion criteria: Stable bedridden oxygen saturation.
patients, male and female both, age between Statistical analysis was done using
15- 85 years. SPSS software version 16 and Microsoft
Exclusion criteria: Patients with cerebral Excel 2017 was used to generate tables.
oedema, head injuries and neurosurgery, Confidence level was kept 95% with
chest x-ray showing pleural effusion, level of significance kept at 0.05. Before
pneumothorax or atelectasis and severe applying statistical tests, the data was
hemodynamically instability. screened for normal distribution. FVC,
Outcome measures: FVC (Forced vital FEV1, RR and SPO2 was not normally
capacity), FEV1 (forced expiratory volume distributed, so nonparametric tests were
in one sec), RR (respiratory rate), SpO2 applied for comparing pre and post values
(oxygen saturation). of individual tests and comparing one test
Thirty patients were divided into with other.
three groups. 10 patients were given Semi
Fowler’s position (group A), 10 patients RESULTS
Right side lying (group B) and 10 patients Total 30 subjects participated in the
were given Left side lying position (group study. Mean age= 55.19± 17.31.There was
C). Patients were given respective positions significant improvement in FVC & FEV1,
and maintained position for 30 minutes. All SpO2 & RR after giving semi fowler’s
the parameters were recorded before and position. There was no significant change
after giving positions. All readings were seen in FVC, FEV1, SpO2 & RR in both left
taken for 3 times and average of readings and right side lying. Comparing semi
was taken into consideration. Before giving Fowler’s position to each of these side
International Journal of Health Sciences and Research (www.ijhsr.org) 54
Vol.11; Issue: 5; May 2021Pooja Patel et.al. A comparison of effect of semi fowler’s and side lying position on pulmonary functions and
oxygen saturation in bedridden patients.
lying positions, semi Fowler’s positioning FEV1, RR and SpO2.
found to be better in improving FVC,
TABLE 1: FVC Before and After Giving Positioning:
POSITION Pre Mean ± SD Post Mean ± SD Z value P value Interpretation
Semi fowler’s 1.132± 0.088 1.474±0.094 -2.805 0.005 Significant
RT side lying 1.108±0.116 1.13±0.150 -0.299 0.765 Not significant
LT side lying 1.128±0.09 1.129±0.08 -0.299 0.765 Not significant
TABLE 2: FEV1 Before and After Giving Positioning:
POSITION Pre Mean ± SD Post Mean ± SD Z value P value Interpretation
Semi fowler’s 0.937± 0.053 1.23±0.100 -2.812 0.005 Significant
RT side lying 0.83±0.06 0.924±0.09 -2.345 0.190 Not significant
LT side lying 0.878±0.08 0.861±0.040 -2.354 0.120 Not significant
TABLE 3: RR Before and After Giving Positioning:
POSITION Pre Mean ± SD Post Mean ± SD Z value P value Interpretation
Semi fowler’s 20.6± 2.01 19±1.63 -2.549 0.010 Significant
RT side lying 19.3±1.15 20±1.24 -1.841 0.066 Not significant
LT side lying 20.6±2.79 20.1±2.68 -1.81 0.060 Not significant
TABLE 4: SPO2 Before and After Giving Positioning:
POSITION Pre Mean ± SD Post Mean ± SD Z value P value Interpretation
Semi fowler’s 95.9± 1.19 99.2±0.63 -2.831 0.005 Significant
RT side lying 96.2±1.39 96.7±1.82 -1.890 0.059 Not significant
LT side lying 96.6±1.77 96.8±1.93 -1.980 0.055 Not significant
TABLE 5: Semi Fowler’s versus RT Side Lying: bedridden patients, potentially increasing
P value significance
FVC 0.001 Significant the risk of portions of lung collapse. There
FEV1 0.000 Significant is decrease in FVC & FEV1 due to
RR 0.152 Not significant
SPO2 0.001 Significant combination of effect of airway obstruction,
increased resistance and loss of elastic recoil
TABLE 6: Semi Fowler’s versus LT Side Lying: as result of structural changes within the
P value significance
FVC 0.001 Significant
lungs. Compressing forces also affects the
FEV1 0.000 Significant heart and cardiac output in supine position.
RR 0.155 Not significant Semi fowler’s position is variant of upright
SPO2 0.000 Significant
position [5].
TABLE 7: RT Side Lying versus LT Side Lying: When in upright position, the
P value Significance diameter of the main airways increases
FVC 1.000 Not significant
FEV1 1.000 Not significant slightly. When a person is in upright, the
RR 1.000 Not significant vertical gravitational gradient is more, the
SPO2 1.000 Not significant
anteroposterior diameter of the chest is
greatest, and compression on heart and
DISCUSSION lungs are minimal [6]. The increase in
The present study was conducted spirometric values in semi fowler’s position
with the aim of comparing different was attributed to descent of diaphragm for
therapeutic positioning in bedridden the extra volume of air inspired during
patients, there were no adverse events forced vital capacity manoeuvre which had
found. Total 30 subjects were included in the highest lung volumes [7].
the study. There was significant Side lying position there is increase
improvement in FVC, FEV1, RR and SpO2 in airflow resistance and a greater excursion
after giving semi fowler’s positioning. on diaphragm as diaphragm ascends
In supine positioning bodyweight upwards [8]. Compared with the semi
restrict free movement of ribcage which fowler’ FVC and FEV1 are reduced in left
decreases lung volumes and capacities. and right side lying because of altered lung
Residual volume of the lung drops in geometry with position change and
International Journal of Health Sciences and Research (www.ijhsr.org) 55
Vol.11; Issue: 5; May 2021Pooja Patel et.al. A comparison of effect of semi fowler’s and side lying position on pulmonary functions and
oxygen saturation in bedridden patients.
reduction in vertical diameter of each lung fowler’s position was found better in
in side lying [9].Manning et al conducted improving FVC & FEV1 in bedridden
study to find effects of positioning on lung patients.
functions and found that FVC and FEV1 are
reduced comparably for right and left side ACKNOWLEDGEMENT
lying positions compared with sitting We are thankful to all the subjects
position. In semi fowler’s position SpO2 is who participated in our study. I am thankful
better than in supine [10]. Blood flow and to my parents, colleagues and all the
ventilation is significantly greater to the staff members of the SBB college of
dependent lung than to nondependent Physiotherapy for their support and
lung[11]. motivation. Special thanks to my guide Dr.
Good V/Q matching at the Sweety Shah for always supporting,
dependent lungs results in the adequate motivating and helping me throughout the
oxygenation in the awake patient who is study.
breathing spontaneously. The related
changes may be due to increase in Conflict of Interest: None
intrathoracic blood volume due to
gravitational facilitation of venous return Source of Funding: None
and upward displacement of diaphragm
caused by abdominal encroachment. The Ethical Approval: Approved
probable reason behind semi fowler’s
position been more effective is gravity, REFERENCES
force length variation observed in 1. Elizaberth Dean et al, Effect of body
respiratory muscles according to several positioning on pulmonary functions:
posture of human body [12]. 2014:;(5)
The FRC in side lying falls between 2. Mark C Rogers“Textbook of Peadiatric
Intensive Care”, 5thedition.
that in upright and supine position. 3. Donna L Frownfelter, Elizabeth Dean
Compared with supine in side lying, “Cardiovascular and pulmonary
compliance is increased, resistance is physiotherapy” 4thedition, published by
reduced, and the work of breathing is Mosboy 1996,
reduced, whereas these measures are 4. David W. Chang,”Clinical Application of
reversed when side lying is compared to Mechanical Ventilation” (2 nd edition);
upright position. That’s why semi Fowler’s Georgia,
position proved to be more effective than 5. William E.De Turek, Lawrence P.
side lying [10]. Cahalin,”Cardiovascular and pulmonary
Limitation of the study is that physical therapy- an evidence based
duration of the treatment for therapeutic approach” 3rdedition,Mc Grow Hill
Publication
position was short. Patients were not 6. Fiona manning. Elizabeth Dean Effects of
divided according to their conditions and sidelying on lung function in older
age. Future studies can be done by dividing individuals:;2013
patients into different group according to 7. Ben-Dov I, Zlobinski R, Segel MJ, Gaides
severity of the diseases and age. Studies can M, Shulimzon T, Zeilig G. Ventilatory
be done for comparing other therapeutic response to hypercapnia in C(5-8) chronic
positioning and to see effects on other tetraplegia: the effect of posture. Arch Phys
parameters of lung functions, DLCO, heart Med Rehabil. 2009
functions etc. 8. Vilke GM, Chan TC, Neuman T, Clausen
JL. Spirometry in normal subjects in sitting,
prone, and supine positions. Respir Care.
CONCLUSION
2000
Comparing semi fowler’s position to 9. Ceridon ML, Morris NR, Olson TP, Lalande
each of these side lying positions, semi S, Johnson BD. Effect of supine posture on
International Journal of Health Sciences and Research (www.ijhsr.org) 56
Vol.11; Issue: 5; May 2021Pooja Patel et.al. A comparison of effect of semi fowler’s and side lying position on pulmonary functions and
oxygen saturation in bedridden patients.
airway blood flow and pulmonary function on Ventilation-Perfusion Relationships in
in stable heart failure. Respir Physiol Severe Adult Respiratory Distress
Neurobiol. 2011 Syndrome”, Chest 1994
10. 4 Lewis ML, Christianson LC. Behavior of
the human pulmonary circulation during How to cite this article: Patel P, Shah S. A
head-up tilt. J Appl Physiol. 1978 comparison of effect of semi fowler’s and side
11. Respiratory physiology, A Clinical lying position on pulmonary functions and
Approach, Schwartzstein & Parke oxygen saturation in bedridden patients. Int J
12. Dirk Pappert, MD; Rolf Rossaint, MD; Health Sci Res. 2021; 11(5): 53-57. DOI:
Klaus Slama, MD “Influence of Positioning https://doi.org/10.52403/ijhsr.20210507
******
International Journal of Health Sciences and Research (www.ijhsr.org) 57
Vol.11; Issue: 5; May 2021You can also read
