Reverse Trendelenburg Position Versus Semi-recumbent Position in Obese Critically Ill Patients

Study Overview
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Brief Summary
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The aim of this study is to assess the effect of reverse Trendelenburg position versus semi-recumbent position on ventilation and oxygenation parameters of obese critically ill patients

Detailed Description
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Obese critically ill patients' position significantly impacts on their ventilation and oxygenation status. It is also associated with mechanical ventilation success or failure and may be a main determinant of the obese patients' outcome. Reverse Trendelenburg position is recommended for obese patients but in critical illness with mechanical ventilation little is known about its effect on respiratory therapeutic targets. This trial was conducted in four general intensive care unit of Alexandria Main University hospital in Alexandria, Egypt. One hundred and ten adult mechanically ventilated patients with body mass index ≥ 30 were randomly assigned by a computer program to either reverse Trendelenburg position group (n=55) which is the intervention group or semi-recumbent position group (n=55) which is the routine unit position. Patients were positioned in the study positions 4 times per day. Patients were maintained in the study positions for 2 hours each time. Baseline ventilation and oxygenation parameters were assessed immediately before positioning then it was reassessed every 10 minutes after positioning for 30 minutes.

Official Title
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Effect of Reverse Trendelenburg Position Versus Semi-recumbent Position on Ventilation and Oxygenation Parameters in Obese Critically Ill Patients: Randomized Controlled Trial

Conditions
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Ventilation and Oxygenation, Obese; Positioning, Critically Ill

Intervention / Treatment
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* Other: Reverse Trendelenburg position
* Other: Semi-recumbent position


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: body mass index ≥ 30 Mechanically ventilated Exclusion Criteria: Trauma Shock Acute respiratory distress syndrome

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: two-group pre-test and repeated post-test study
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Reverse Trendelenburg position group<br>Obese critically ill patients who are positioned in reverse Trendelenburg position | Other: Reverse Trendelenburg position<br>* The Reverse Trendelenburg position is a position in which patients' hip and knee are not flexed but the head and chest are elevated at 30° than the abdomen and legs.<br>|
| Active Comparator: Semi-recumbent position group<br>Obese critically ill patients who are positioned in semi-recumbent position which is the routine ICU position | Other: Semi-recumbent position<br>* The semi-recumbent position is an upright positioning of the head and torso at an angle of 45° while legs are lying on the bed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Respiratory dynamic compliance | Respiratory dynamic compliance (Cdyn) in ml/cm H2O is the change in lung volume per unit change in pressure in the presence of flow. It is calculated through the equation of tidal volume/ (peak inspiratory pressure - positive end expiatory pressure). All the previous equation variables are assessed from the patient's mechanical ventilator data. | 30 minute form positioning time | 
| Respiratory minute volume | Respiratory minute volume (VE) in mL/min is the total volume of air that is expired over one minute. It is calculated directly by the mechanical ventilator and presented on patient's mechanical ventilator data. | 30 minute form positioning time | 
| Partial pressure carbon dioxide | Partial pressure carbon dioxide (PaCO2) in mm Hg is assessed from arterial blood gases sample. | 30 minute form positioning time | 
| Partial pressure oxygen | Partial pressure oxygen (PaO2) in mm Hg is assessed from arterial blood gases sample. | 30 minute form positioning time | 
| Hypoxemic index | Hypoxemic index is the ratio of partial pressure oxygen to fraction inspiratory oxygen (PaO2/FiO2). | 30 minute form positioning time | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Reverse Trendelenburg position, semi-recumbent position, ventilation, oxygenation, obese patients