The effect of positional changes on oxygenation in patients with head injury in the intensive care unit

Following head injury, cardiopulmonary functions are impaired and this disturbs the oxygenation transport pathway. Expanding cardiopulmonary physical therapy to encompass the oxygen transport system as a whole has implication for treatment as well as assessment and treatment outcome. Therefore, the aim of the study is to assess the oxygenation level in head injury patients with relation to body positioning in the intensive care unit (ICU).

Thirty consecutive patients with head injury with hemodynamically stable were included from the surgical ICU, ages ranging from 15 to 50 years. Noninvasive vital parameters (oxygen saturation [SpO₂], pulse rate [PR], respiratory rate [RR], and blood pressure [BP]) were observed and recorded in different body positions at regular intervals of 5 min for 15 min in each position.

There was increment in SpO₂ value in all positions from 0 min to end of 15 min in supine (98.63 ± 0.36-98.73 ± 0.30), right-side lying (98.77 ± 0.30-98.93 ± 0.20), left-side lying (98.73 ± 0.29-99.03 ± 0.24), and recline sitting (30°-70°) (99.03 ± 0.24-99.50 ± 0.22). However, there was statistically significant increment in recline sitting (30°-70°) compared to other positions (P = 0.036) while other parameters (PR, RR, and BP) were getting stabilized at lower values at end of 15 min in every positions tested.

We conclude that upright position bring about significant increase in arterial SpO₂ compared to any other positions. Other vital parameters were seen to stabilize at lower values at the end of 15 min in every position tested.