Patient Positioning and Kinetic Therapy in the Critically Ill Patient:Pathophysiology, Methods and Indications

Overview

Acute respiratory failure is characterized by arterial hypoxaemia, requiring endotracheal intubation and respiratory therapy. Therapeutic strategiesinclude the therapy of the underlying disease (e.g. sepsis, trauma), various techniques of ventilation, fluid replacement and enteral or parenteralnutrition. In recent years, supplementary techniques of patient positioning such as intermittent prone position or continuous axial rotation therapyhave been successfully introduced into clinical practice in order to reduce ventilator-associated lung damage and to improve pulmonary gas exchange.For a rational and beneficial use of these techniques in the therapy of critically ill patients, a detailed knowledge of the pathophysiology of acuterespiratory failure is essential. The pros and cons of this techniques including their complications and benefits are described. Kinetic therapy shouldbe established as soon as possible in the treatment of patients with severe respiratory failure. Although a rationale for differential use of kinetic therapyexists, the definite decision for supplementary kinetic therapy and the choice of the method applied depends on the patient’s individual status andpersonal experience of the medical staff.

Key words:
acute respiratory failure - kinetic therapy - prone position - continuous axial rotation