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Arterial oxygenation changes in valvular heart disease patients with cardiomegaly in different recumbent positions

Published online by Cambridge University Press:  13 October 2005

G. D. Puri ,
A. Dutta ,
N. K. Chinnan ,
S. K. S. Thingnam ,
S. K. Sharma  and
P. Chari
G. D. Puri
Affiliation:
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
A. Dutta
Affiliation:
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
N. K. Chinnan
Affiliation:
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
S. K. S. Thingnam
Affiliation:
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
S. K. Sharma
Affiliation:
Punjab University, Department of Statistics, Chandigarh, India
P. Chari
Affiliation:
Post Graduate Institute of Medical Education and Research (PGIMER), Department of Anaesthesia and Intensive Care and Department of Cardiothoracic and Vascular Surgery, Chandigarh, India
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Extract

Summary

Background and objective: We studied the effect of different recumbent positions (supine, left and right lateral decubitus), on arterial oxygenation in 42 valvular heart disease patients planned for cardiac surgery. All patients had cardiomegaly (cardiothoracic ratio ≥0.5) in their chest X-rays. Their left ventricular end-diastolic diameter was also noted from the preoperative echocardiogram. Methods: Arterial blood gas analysis was performed in supine, left and right lateral positions after keeping the patient in a given position for 15 min. During this period all patients received 35% oxygen supplementation. Results: Arterial oxygen tension and haemoglobin saturation were significantly higher in the right lateral position (PaO2 = 120.6 ± 29.5 mmHg, SaO2 = 98.1 ± 1.4%) than in supine (PaO2 = 111.0 ± 30.6 mmHg, SaO2 = 97.6 ± 2.2%) and left lateral positions (PaO2 = 109.7 ± 32.0 mmHg, SaO2 = 97.6 ± 1.7%; mean ± SD; P < 0.01). There was no significant difference in arterial oxygenation between left lateral and supine positions (P > 0.05). The change in PaO2 and SaO2 with change of posture from left to right was significantly related to left ventricular end-diastolic diameter (r = 0.50 and r = 0.63, respectively; Pearson correlation). Repeated measures of analysis of variance with left ventricular end-diastolic diameter as a covariate showed a significant change in arterial PaO2 with posture (P = 0.011). Conclusion: Right lateral posture improves arterial oxygenation in the valvular heart disease patient with an enlarged left ventricle. In the preoperative period, these patients may benefit from a right lateral posture when lying in bed.

Keywords

POSTUREOXYGEN INHALATION THERAPYHEART VALVE DISEASESCARDIOMEGALYPULMONARY GAS EXCHANGE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 11 , November 2005 , pp. 834 - 838
Copyright
© 2005 European Society of Anaesthesiology

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References

Dean E. Effect of body position on pulmonary function. Phs Ther 1985; 65: 613–618.Google Scholar
Ross J, Dean E. Body positioning. In: Zadaic C, ed. Clinics in Physical Therapy: Pulmonary Management in Physical Therapy. New York, USA: Churchill Livingstone Inc, 1992: 78–98.
Remolina C, Khan AU, Santiagotv TV, Edelman NH. Positional hypoxemia in unilateral lung disease. New Engl J Med 1981; 304: 523–525.Google Scholar
Sonnenblick M, Melzer E, Rosin AJ. Body positional effect on gas exchange in unilateral pleural effusion. Chest 1983; 83: 784–786.Google Scholar
Neagley SR, Zwillich CW. The effect of positional changes on oxygenation in patients with pleural effusions. Chest 1985; 88: 714–717.Google Scholar
Zack MB, Pontoppidan H, Kazemi H. The effect of lateral position on gas exchange in pulmonary disease: a prospective evaluation. Am Rev Respir Dis 1974; 110: 49–55.Google Scholar
Weiner CM, Mckenna WJ, Lavender JP, Hughes JMB. Left lower lobe ventilation is reduced in patients with cardiomegaly in the supine but not prone position. Am Rev Resp Dis 1990; 14: 1150–1155.Google Scholar
Mark SM, Arnot RN, Lavender JP. Left lower lobe ventilation and its relation to cardiomegaly and posture. BMJ 1989; 299: 94.Google Scholar
Alexander MS, Peters AM, Cleland JP, Lavender JP. Impaired left lower lobe ventilation in patients with cardiomegaly: an isotope study of mechanisms. Chest 1992; 101: 1189–1193.Google Scholar
Corr L, Mccarthy PJ, Lavender JP, Hallidie-Smith KA. Bronchial compression by an enlarged left atrium in infants: a cause of hypervascularity of the left lung. Paed Radiol 1988; 18: 459–463.Google Scholar
Beckman CF, Levin DC, Ulreich S. Cardiomegaly as a cause of non-uniform pulmonary artery perfusion. Am J Roentgenol 1977; 129: 661–666.Google Scholar
Banasik JL, Emerson RJ. Effect of lateral position on arterial and venous blood gases in postoperative cardiac surgery patients. Am J Crit Care 1996; 5: 121–126.Google Scholar
Raphel MJ, Donaldson RM. The normal heart: methods of examination. In: Sutton D, ed. Textbook of Radiology and Imaging, 5th edn. London, UK: Churchill Livingstone Inc, 1998: 541–565.
Benumof JL, Alfrey DD. Anaesthesia for thoracic surgery. In: Miller RD, ed. Anaesthesia, 5th edn. Philadelphia, USA: Churchill Livingstone, 2000: 1665–1752.
Leung RS, Bowman ME, Parker JD, Newton GE, Bradley TD. Avoidance of the left lateral decubitus position during sleep in patients with heart failure: relationship to cardiac size and function. J Am Coll Cardiol 2003; 41: 227–230.Google Scholar
Berensztein CS, Pineiro D, Luis JF, Iavicoli O, Lerman J. Effect of left and right lateral decubitus positions on Doppler mitral flow patterns in patients with severe congestive heart failure. J Am Soc Echocardiogr 1996; 9: 86–90.Google Scholar
Miyamoto S, Fujita M, Sekiguchi H et al. Effects of posture on cardiac autonomic nervous activity in patients with congestive heart failure. J Am Coll Cardiol 2001; 37: 1788–1793.Google Scholar
Hada Y. Cardiothoracic ratio. J Cardiol 1995; 26: 51–54.Google Scholar