Influence of the Bed Head Positioning on the Current Expiratory Volume of Pediatric Patients in Mechanical Ventilation: A Pilot Clinical Controlled Trial

Abstract

he elevated bed head position is an important therapeutic intervention that can reduce respiratory complications associated with mechanical ventilation. The objective of this study was to evaluate the effects of elevation at the head of the bed on the tidal volume, pressure variables, hemodynamic data and peripheral oxygen saturation in pediatric patients on mechanical ventilation. Methods: In a before-and-after clinical trial, 52 patients of both sexes, with a chronological age of 28 days to 14 years old, were admitted to the pediatric intensive care unit for more than 24 hours. These were positioned at 0º, 30º, 45º and 60º of elevation of the head of the bed. For each position, the expiratory tidal volume, pressure variables, hemodynamic data and peripheral oxygen saturation were evaluated. Results: The patients presented an increase in the expired tidal volume, with the bed head angulation at 30º and 45º. Heart rate increased when the head was positioned at 60º. The peripheral oxygen saturation variable increased in the 30º and 45º positions. The systolic blood pressure variables and diastolic blood pressure showed a progressive increase in the 30º, 45º and 60º positions respectively. Significant effects on increasing the SatO2/FiO2 ratio were observed in the 30º and 45º positions. Conclusion: This study demonstrated a significant increase in expired tidal volume and an increase in the SatO2/FiO2 ratio with the patient positioned at 30º and 45º of elevation of the head of the bed. The peripheral oxygen saturation variable increased in the 30º and 45º positions. The elevated bed head position should be considered when monitoring children during mechanical ventilation.