How a patient is positioned can have a dramatic impact on blood oxygenation and breathing function. Not only does oxygenation and proper respiration affect a patient’s comfort level and recovery, but some patients (especially those in intensive care units) may also be at risk for ARDS (acute respiratory distress syndrome).

With the optimal patient position, we can avoid further lung damage, reduce mortality rates due to ARDS, aid patient recovery, and increase overall comfort levels. If you’d like to explore the dorsal recumbent or semi-recumbent position, look here. We’re going to look at some of the causes of respiratory problems and the best patient positions to promote oxygenation and easier respiration.

 

Conditions That Affect Breathing And Oxygenation

 

There are a large number of conditions, illnesses, and injuries that can affect a patient’s breathing and blood oxygen levels. Respiratory problems were brought to the forefront with the outbreak of the COVID-19 virus and the respiratory distress it can cause.

Even before the coronavirus, there is a long list of conditions that impact a patient’s breathing, including:

  • ARDS (acute respiratory distress syndrome)
  • COPD (chronic obstructive pulmonary disease)
  • Emphysema
  • Asthma
  • Pneumonia
  • COVID-19
  • Interstitial Lung Disease
  • Neuromuscular Disease
  • Restrictive Lung Disease
  • Chest injuries
  • Inhalation injuries

From mild to severe distress, intubation, or a nose cannula – no matter what the recommendation to improve breathing and blood oxygen level, perhaps the most critical remedy is to make sure that the patient is in the best position. Research has shown that certain patient positions can not only help a patient breathe easier, but improve oxygenation.

 

The Best Patient Positions To Improve Oxygenation

 

Whether intubated or breathing on their own, the prone position has shown to have a positive impact on blood oxygen levels. But there are two other positions that are also commonly used to increase lung function and improve oxygenation. 

Let’s take a look at all three positions:

 

Prone Position

The prone position has the patient lying on their stomach (ventral side) with their back facing up with their legs straight and arms at their sides. The reason this position is so helpful in patients with respiratory distress are:

  • Improved respiratory mechanics
  • Equalizing lung pressure
  • Increased lung volume
  • Reduced ventilator-associated lung injury
  • Improved drainage of secretions

Patients were proned for different averages of time including 3 hours and 16 – 18 hours, after which they were moved into a supine position. Overall oxygenation significantly improved as did lung function and ease of breathing.

However, the prone position isn’t indicated for all patients. Patients who have any of the following conditions are not recommended for the prone position:

  • Spinal instability
  • Unstable fractures
  • Open wounds
  • Burns
  • Tracheal surgery
  • A baby in utero

 

Fowler’s Position

Fowler’s position is commonly used in practice to promote oxygenation by permitting maximum chest expansion. In the position, the patient is in the supine position with the head of the bed inclined from 15 to 90 degrees.

There are 4 variations of Fowler’s position:

  • Low Fowlers – 15 to 30 degrees
  • Semi Fowlers – 30 to 45 degrees
  • Standard Fowler’s – 45 to 60 degrees
  • High Fowler’s – 90 degrees

A study that looked at the effects of position changes on arterial oxygen saturation in cardiac and respiratory patients found higher oxygen levels in patients who were in a Semi-Fowler’s position as opposed to prone or supine positions.

 

Orthopneic Position

The orthopneic position is designed to alleviate difficulty breathing due to orthopnea, or the condition in which it’s hard to breathe in any other position other than sitting up. 

This position has the patient sitting up (a High Fowler’s position) with their head, arms, and torso resting on a support (a table or platform). A large pillow is often used to cushion the head and arms.

The orthopneic (or tripod) position also allows for maximum chest expansion with the added benefit of aiding exhalation. This is especially useful for patients with COPD or emphysema.

 

What Research Shows About Patient Positioning

 

A study published in the Canadian Respiratory Journal sought to test whether patient positioning could improve oxygenation in patients with ARDS. ARDS is a condition that usually occurs in patients who are critically ill or have sustained severe injuries. In ARDS, the lungs fill with fluid preventing oxygen from reaching the patient’s bloodstream, lowering blood 02 levels, and thus depriving the organs of the oxygen needed to function.

The researchers found persuasive evidence and data to suggest that the prone position increased oxygenation and improved mortality rates in patients with ARDS. 

Though the researchers state that further research is needed, the results are just as persuasive as the physical evidence was. Another study also found improved blood oxygenation levels in the prone position for patients with COVID-19-related pneumonia. Want a deeper dive into a complete list of patient body positions? You can find it here.

 

An oxygen mask, nasal cannula, or even intubation sometimes isn’t enough to relieve a patient’s respiratory distress. These measures in addition to proper positioning, however, can relieve pressure on the chest, improve lung function, promote chest expansion, and increase overall blood oxygenation. And almost as important as proper positioning is using these tips for safely transferring a patient whether you’re moving them from bed or repositioning them in bed.

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