positioning for VQ & breathing exercises

Question 1

how to perform

Answer 1

introduce, explain purpose, contraindications, informed consent, suitable environment, position appropriately using pillows and provide towel/blanket for comfort as
required, observe effects, monitor, re-assess
if a person is placed on their right side, the right lung is the dependant lung and will therefore have better perfusion and better ventilation

breathing control - relaxed, gentle, hand on abdomen, patients hands on thighs
thoracic expansion - deeper, hand on chest wall/mid/axillary line/7th rib, add pressure on end of expiration

Question 2

contraindications / precautions

Answer 2

MSK: head/neck/spinal injury, rib fracture
CR: haemoptysis/coughing blood, Broncho-pleural fistula, undrained pneumothorax
CV: hemodynamic instability, pulmonary embolism, heart failure
N: recent epidural to spine

illness, CV instability, raised intracranial pressure, recent thoracic/abdominal/spinal surgery, burns/wounds

inability to participate
acute pain/bronchospasm, medically unwell

Question 3

rational

Answer 3

alveolar ventilation brings oxygen into the lungs, removes CO2
lung perfusion delivers blood to the alveoli for gas exchange
gravity optimising VQ ratio in dependent area

BC - Ps gain control of breathing with minimal effort
TE - increasing the lateral movement of the chest particularly towards the lower lobes of the lung - bucket handle movement

Question 4

principles

Answer 4

patient comfort + safety
ventilation and perfusion will both increase towards the dependent area of lung
gravity assissted positioning
understanding VQ mismatch - optimal VQ ratio in middle of lung
optimal VQ - opposite side lying
improving - same side lying

normal gentle breathing at tidal volume
arms supported and upper chest, shoulders and hands relaxed

Question 5

structures

Answer 5

alveoli, pulmonary blood vessels, lungs - by gravity moving blood to dependent part of lung, opening alveoli, compressing vessels to increase vascular resistance
channels of martin, canals of lambert, pores of kohn - collateral ventilation, reinflation

Question 6

physiological effects

Answer 6

alter VQ ratio in area of lung, optimal VQ, more efficient gas exchange, easier breathing
VQ increases towards dependent area of lung
air through pores of kohn, canals of lambert, channels of martin, enhanced oxygenation
lungs more compliant
increased functional residual capacity/alveoli expansion during rest
lessen alveolar shunt + dead space
collateral ventilation - air moves behind secretions, better moved/cleared
re-inflates collapsed alveoli