![]() (4) Study population of non-mechanically ventilated subjects. (3) Outcome measures included assessment of lung function by forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, vital capacity (VC), functional residual capacity (FRC), maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), peak expiratory flow (PEF), total lung capacity (TLC), residual volume (RV), or diffusing capacity of the lungs for carbon monoxide (DLCO). (2) Two or more body positions compared, including at least the sitting or standing position. We aimed to systematically review studies that evaluated the effect of body position on lung function in healthy subjects and non-mechanically ventilated patients with lung disease, heart disease, SCI, neuromuscular disease, and obesity.Īrticles were included if they met the following criteria: (1) Quasi-experimental, pre-post intervention. However, we did not find a systematic review that integrates findings from studies involving non-mechanically ventilated adults to derive clinical implications for respiratory care and pulmonary function test (PFT) execution. One of the main goals of positioning, and specifically the use of upright positions, is to improve lung function in patients with respiratory disorders, heart failure, neuromuscular disease, spinal cord injury (SCI), and obesity, and in the past 20 years, various studies regarding the influence of body position on respiratory mechanics and/or function have been published. However, people who suffer from neuromuscular disease, morbid obesity, and other conditions may find it difficult to sit or stand during this test, which may influence their results. Sitting is preferable for safety reasons to avoid falling due to syncope, and might also be more convenient because of the measurement devices and patient comfort. According to ATS/ERS guidelines, PFTs may be performed either in the sitting or standing position, and the position should be recorded on the report. Spirometric examination is the most common form of PFT. They are used to evaluate and monitor diseases that affect heart and lung function, to monitor the effects of environmental, occupational, and drug exposures, to assess risks of surgery, and to assist in evaluations performed before employment or for insurance purposes. Pulmonary function tests (PFTs) provide objective, quantifiable measures of lung function. When treating patients with heart, lung, SCI, neuromuscular disease, or obesity, one should take into consideration that pulmonary physiology and function are influenced by body position. We recommend the supine position should be considered in addition to sitting for PFTs in patients with SCI and neuromuscular disease. PFTs are routinely performed in the sitting position. Conclusionsīody position influences the results of PFTs, but the optimal position and magnitude of the benefit varies between study populations. In patients with chronic heart failure, the effect of position on DLCO varied. In healthy subjects, DLCO was higher in the supine vs. For subjects with tetraplegic SCI, FVC and FEV1 were higher in supine vs. In most studies involving healthy subjects or patients with lung, heart, neuromuscular disease, or obesity, FEV1, FVC, FRC, PEmax, PImax, and/or PEF values were higher in more erect positions. ![]() The study populations included healthy subjects (29 studies), lung disease (nine), heart disease (four), spinal cord injury (SCI, seven), neuromuscular diseases (three), and obesity (four). Resultsįorty-three studies met inclusion criteria. Standing, sitting, supine, and right- and left-side lying positions were studied. ![]() ![]() Primary outcome measures were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC, FEV1/FVC), vital capacity (VC), functional residual capacity (FRC), maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), peak expiratory flow (PEF), total lung capacity (TLC), residual volume (RV), and diffusing capacity of the lungs for carbon monoxide (DLCO). Studies that were quasi-experimental, pre-post intervention compared ≥2 positions, including sitting or standing and assessed lung function in non-mechanically ventilated subjects aged ≥18 years were included. MethodsĪ search to identify English-language papers published from 1/1998–12/2017 was conducted using MEDLINE and Google Scholar with key words: body position, lung function, lung mechanics, lung volume, position change, positioning, posture, pulmonary function testing, sitting, standing, supine, ventilation, and ventilatory change. This systematic review investigated the influence of body position on lung function in healthy persons and specific patient groups. Pulmonary function tests (PFTs) are routinely performed in the upright position due to measurement devices and patient comfort.
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