I was recently having a discussion with one of the agencies in charge of training lifeguards in our area. For years, lifeguards have put patients in a lateral position when performing Artificial Respirtation on a near drowning patient. The agency was told by one of their advisors that lateral AR (out of hospital) is not as effective as supine resuscitation do to limitations of chest expansion. However, their reasoning for using the lateral position (as stated by the agency) is because of the high rate of vomitting following a near drowning experience. Could someone please provide accurate information in this regard (articles relating to lateral ventilation would be greatly appreciated)? Thanks.
Lateral vs supine resuscitation?
- Thread starter canuck MD
- Start date
- Joined
- Aug 3, 2003
- Messages
- 2,080
- Reaction score
- 3
canuck said:
Interesting post....
I was a chief lifeguard for New York State Parks and Recreation for a good portion of the 90's. I read about doing lateral AR but we always followed the AHA regulations on CPR and rescue breathing. If there was vomiting then you would turn the victim and do your best to clear the airway. Obviously, I didn't have access (or were they trained) to a suction device but we did use BVM's connected to O2.
I don't have any articles on the difference but I thought I would just point out that aspect cause NYS is pretty damn anal when it comes to regulations.
- Joined
- Aug 3, 2003
- Messages
- 2,080
- Reaction score
- 3
Well I found this....
Heart Lung. 2001 Jul-Aug;30(4):269-76.
Effect of lateral positions on tissue oxygenation in the critically ill.
Banasik JL, Emerson RJ.
Washington State University College of Nursing, USA.
OBJECTIVE: The purpose of this study was to assess the effect of lateral positions on tissue oxygenation in critically ill patients. DESIGN: The study design was prospective and quasi-experimental, and we used a convenience sample with random assignment. SETTING: The study took place in the intensive care unit and the cardiac intensive care unit of a 450-bed medical center in the northwestern United States. PATIENTS: The sample included 12 adult patients with indwelling pulmonary artery and radial arterial catheters who were receiving mechanical ventilation and who met the criteria of "critical illness" by having impaired arterial oxygenation (PaO2 < or = 70 mm Hg) and/or cardiac index < or = 2.0 L/min/m2. OUTCOME MEASURES: The outcome measures were dependent variables reflecting oxygen delivery including heart rate, cardiac output, arterial oxygen content (CaO2) and oxygen consumption, and the adequacy of tissue oxygenation (serum lactate). INTERVENTION: Each patient was passively turned to each of the three positions (right and left 45 degrees lateral and supine) according to a computer-generated, randomized positioning sequence. Dependent variables were measured 15 minutes after each position change. No changes in ventilator settings or vasoactive drugs occurred during data collection. RESULTS: Analysis of variance for repeated measures was used in the data analysis. Post hoc analysis determined an effect size of 0.558 and power of 0.80 at an alpha level of.05. No statistically significant differences caused by position were found in mean CaO2, cardiac output, heart rate, respiratory rate, PaO2, SaO2, or lactate level. Pearson correlation analysis found no significant relationships between the primary variables reflecting oxygen delivery (cardiac output and CaO2) and serum lactate levels. CONCLUSIONS: These findings suggest that lateral positioning of critically ill patients who are hypoxemic or have low cardiac output does not further endanger tissue oxygenation. Evaluation of individual patient responses to position changes in the clinical setting is encouraged until further studies using more heterogenous populations can provide more definitive guidance.
Heart Lung. 2001 Jul-Aug;30(4):269-76.
Effect of lateral positions on tissue oxygenation in the critically ill.
Banasik JL, Emerson RJ.
Washington State University College of Nursing, USA.
OBJECTIVE: The purpose of this study was to assess the effect of lateral positions on tissue oxygenation in critically ill patients. DESIGN: The study design was prospective and quasi-experimental, and we used a convenience sample with random assignment. SETTING: The study took place in the intensive care unit and the cardiac intensive care unit of a 450-bed medical center in the northwestern United States. PATIENTS: The sample included 12 adult patients with indwelling pulmonary artery and radial arterial catheters who were receiving mechanical ventilation and who met the criteria of "critical illness" by having impaired arterial oxygenation (PaO2 < or = 70 mm Hg) and/or cardiac index < or = 2.0 L/min/m2. OUTCOME MEASURES: The outcome measures were dependent variables reflecting oxygen delivery including heart rate, cardiac output, arterial oxygen content (CaO2) and oxygen consumption, and the adequacy of tissue oxygenation (serum lactate). INTERVENTION: Each patient was passively turned to each of the three positions (right and left 45 degrees lateral and supine) according to a computer-generated, randomized positioning sequence. Dependent variables were measured 15 minutes after each position change. No changes in ventilator settings or vasoactive drugs occurred during data collection. RESULTS: Analysis of variance for repeated measures was used in the data analysis. Post hoc analysis determined an effect size of 0.558 and power of 0.80 at an alpha level of.05. No statistically significant differences caused by position were found in mean CaO2, cardiac output, heart rate, respiratory rate, PaO2, SaO2, or lactate level. Pearson correlation analysis found no significant relationships between the primary variables reflecting oxygen delivery (cardiac output and CaO2) and serum lactate levels. CONCLUSIONS: These findings suggest that lateral positioning of critically ill patients who are hypoxemic or have low cardiac output does not further endanger tissue oxygenation. Evaluation of individual patient responses to position changes in the clinical setting is encouraged until further studies using more heterogenous populations can provide more definitive guidance.
