[kfmh311]

Hi everyone,

I am new to this forum. Currently, I work in a respiratory unit and would like to seek your advice.

I have noticed that many patients on respiratory failure prefer to lean forward with the head hunched over the chest while sitting in bed. Some of them even sleep in this posture which seems extremely uncomfortable to me,especially when the head droops to either side of the neck.

I have tried several arrangements of pillows/linen to try to stabilise the head but nothing seems to work satisfactorily. Would someone like to share her experience/tips on this issue please?

Many thanks

Cindy

[bmxRRT]

Well it sounds like it's orthopnea.

Usually chronic respiratory patients like to sleep sitting up(with pillows behind their back) because the leaning forward position provides their AP chest to expand easier than being supine, and they generally feel more comfortable. This is due to the air trapping they have and the emphysemetous alveoli(floppy and baggy). You can sort of relate this posture to tri-poding. Also since their diaphragms are blunted, they don't feel like they can expand their lungs whilst supine.

I've experienced patients like this at a MINIMUM of a 30 degree angle of back of bed, all the way to 45 degrees with pillows behind their head. These chronic lungers basically feel more comfortable because they can feel they can breathe a lot easier sitting semi to full fowlers position. This pertains to vent patients as well.