Effect of lateral and semi-recumbent positions on the prognosis of stroke patients with pneumonia and respiratory failure

Abstract

Objective To explore the effect of lateral and semi-recumbent positions on the prognosis of stroke patients with pneumonia and respiratory failure. Methods A total of 68 stroke patients with pneumonia and respiratory failure requiring invasive mechanical ventilation were selected from January 2015 to July 2017 in the Department of Intensive Care Unit of First Affiliated Hospital of Harbin Medical University, who were divided into the lateral position group (37 cases) and semi-recumbent group (31 cases). The age, sex ratio, acute physiology and chronic health evaluation (APACHE) Ⅱ score, stroke type and other general data were recorded in both groups. The sputum volume, oxygenation index, clinical mortality, success rate of deventilator, duration of mechanical ventilation, ICU length of hospital stay between the two groups during mechanical ventilation, as well as the heart rate and mean arterial pressure before and after lateral position in the lateral position group, were compared. Prognostic factors of stroke patients with pneumonia and respiratory failure were analyzed by Logistic regression. Results On the 3rd and 5th days of mechanical ventilation, the sputum volume was (41 ± 18) and (35 ± 16) mL for patients in the lateral position group and (66 ± 30) and (57 ± 29) mL for patients in the semi-recumbent position group, respectively. The differences between the two groups were both statistically significant (t=4.179, 2.776; all P < 0.05). On the 5th day of mechanical ventilation, the oxygenation index of patients was significantly higher in the lateral position group than in semi-recumbent position group [(288+43) mmHg vs. (254+32) mmHg; t=2.802, P=0.008]. The heart rates 5 min before and 5 min and 15 min after lateral position in the lateral position group were (92 ± 16), (100 ± 17) and (96 ± 17) times/min, and the mean arterial pressure were (109 ±12), (115 ± 11) and (112 ±11) mmHg, respectively. The results showed that the heart rate and mean arterial pressure were significantly higher in the 5 min and 15 min after lateral position than in the 5 min before lateral position (all P<0.001). The duration of mechanical ventilation in the lateral position group was significantly lower than that in the semi-recumbent position group [4 (4, 7) d vs. 6 (5, 10) d; χ2=2.601, P=0.009]. The position, sex, age, APACHEⅡscore and stroke type were included in Logistic regression analysis. It found that age [OR=0.921, 95%CI (0.860, 0.985), P=0.017] was a protective factor for prognosis in stroke patients with pneumonia and respiratory failure, and the APACHEⅡ score [OR=1.357, 95%CI (1.162, 1.584), P<0.001] was a risk factor. Conclusion The lateral position can significantly reduce the amount of sputum per day, improve the oxygenation index and shorten mechanical ventilation time in stroke patients with pneumonia and respiratory failure, but it has no effect on the mortality of patients. Key words: Stroke; Pneumonia; Respiratory failure; Lateral body position; Mechanical ventilation time