What Can Be Done in Order to Increase Comfort for a Patient While in the Prone Position?

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• Published: 11 October 2018

The effect of body position on pulmonary function: a systematic review

BMC Pulmonary Medicine book 18, Article number:159 (2018) Cite this article

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Abstract

Background

Pulmonary function tests (PFTs) are routinely performed in the upright position due to measurement devices and patient condolement. This systematic review investigated the influence of body position on lung office in good for you persons and specific patient groups.

Methods

A search to identify English-linguistic communication papers published from 1/1998–12/2017 was conducted using MEDLINE and Google Scholar with cardinal words: body position, lung role, lung mechanics, lung volume, position modify, positioning, posture, pulmonary function testing, sitting, continuing, supine, ventilation, and ventilatory change. Studies that were quasi-experimental, pre-post intervention; compared ≥ii positions, including sitting or continuing; and assessed lung function in non-mechanically ventilated subjects aged ≥xviii years were included. Primary effect measures were forced expiratory volume in ane s (FEV1), forced vital chapters (FVC, FEV1/FVC), vital chapters (VC), functional residual capacity (FRC), maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), peak expiratory menstruum (PEF), full lung capacity (TLC), rest volume (RV), and diffusing capacity of the lungs for carbon monoxide (DLCO). Standing, sitting, supine, and right- and left-side lying positions were studied.

Results

Forty-iii studies met inclusion criteria. The study populations included salubrious subjects (29 studies), lung disease (nine), heart disease (iv), spinal string injury (SCI, vii), neuromuscular diseases (three), and obesity (four). 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 college in more than erect positions. For subjects with tetraplegic SCI, FVC and FEV1 were higher in supine vs. sitting. In salubrious subjects, DLCO was higher in the supine vs. sitting, and in sitting vs. side-lying positions. In patients with chronic heart failure, the event of position on DLCO varied.

Conclusions

Body position influences the results of PFTs, only the optimal position and magnitude of the benefit varies between written report populations. PFTs are routinely performed in the sitting position. Nosotros recommend the supine position should be considered in addition to sitting for PFTs in patients with SCI and neuromuscular disease. When treating patients with eye, lung, SCI, neuromuscular disease, or obesity, one should take into consideration that pulmonary physiology and office are influenced by trunk position.

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Groundwork

Pulmonary role tests (PFTs) provide objective, quantifiable measures of lung office. They are used to evaluate and monitor diseases that impact heart and lung function, to monitor the effects of environmental, occupational, and drug exposures, to assess risks of surgery, and to assistance in evaluations performed before employment or for insurance purposes. Spirometric examination is the virtually common grade of PFT [i]. According to ATS/ERS guidelines, PFTs may be performed either in the sitting or standing position, and the position should exist recorded on the report. Sitting is preferable for safe reasons to avert falling due to syncope [2], and might also exist more convenient because of the measurement devices and patient comfort. 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.

One of the main goals of positioning, and specifically the use of upright positions, is to amend lung function in patients with respiratory disorders, heart failure, neuromuscular disease, spinal cord injury (SCI), and obesity, and in the past 20 years, diverse studies regarding the influence of body position on respiratory mechanics and/or office accept been published. Nonetheless, 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 role test (PFT) execution.

Nosotros aimed to systematically review studies that evaluated the effect of trunk position on lung function in healthy subjects and non-mechanically ventilated patients with lung disease, heart affliction, SCI, neuromuscular disease, and obesity.

Methods

Two researchers (SK., Due east-LM.) searched MEDLINE and Google Scholar for studies published from January 1998–Dec 2022 using the key words body position, lung office, lung mechanics, lung volumes, position change, positioning, posture, PFTs, sitting, continuing, supine, ventilation, and ventilatory change, in various combinations. Each search term combination included at least i central word related to pulmonary function and at least i related to trunk position. The year 1998 was chosen as the beginning point due to the publication of the seminal report by Meysman and Vincken [3]. A full of 972 abstracts identified in the search were screened by the same two researchers, and full text of 151 potentially relevant articles was obtained. The full texts were evaluated and categorized, and 108 articles not fulfilling the inclusion criteria were excluded (Fig. ane).

Fig. ane

Study flow diagram

Full size epitome

Articles were included if they met the post-obit criteria: (1) Quasi-experimental, pre-postal service intervention. (2) Two or more torso positions compared, including at least the sitting or standing position. (three) Event 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 force per unit area (PImax), tiptop expiratory flow (PEF), total lung capacity (TLC), residue volume (RV), or diffusing capacity of the lungs for carbon monoxide (DLCO). (four) Study population of not-mechanically ventilated subjects. (5) Participants aged ≥eighteen years. (6) English language. Studies assessing lung function using other criteria and those without statistical comparisons of lung part in different positions, those enrolling individuals < 18 years or on mechanical ventilation, published conference abstracts, and systematic reviews were excluded.

Positions studied

1. 1.

   Standing – unsupported agile standing

2. ii.

   Sitting – sitting on a chair or wheelchair with the backrest at 90° and all limbs supported

3. 3.

   Supine – lying flat on the dorsum

4. 4.

   Right-side lying (RSL) – lying directly on the right side

5. 5.

   Left-side lying (LSL) – lying direct on the left side

Upshot measures and defined thresholds for clinical significance

1. 1.

   FVC – forced vital chapters

   • Change of 200 ml or 12% from baseline values in FVC [iv]

2. two.

   FEV1– forced expiratory volume in 1 s

   • Modify of 200 ml or 12% from baseline values in FEV1 [4]

3. 3.

   FEV1/FVC – forced expiratory book in 1 southward divided by forced vital chapters

   • FEV1/FVC < 0.7 is defined as obstructive disease

4. 4.

   VC – vital capacity

5. v.

   FRC – functional residual capacity

   • Change > 10% [v]

6. vi.

   TLC – total lung capacity

   • Change > ten% [five]

7. vii.

   RV – residual volume

8. 8.

   Maximal expiratory pressure (PEmax)

   • Modify ≥24 cmH2O [6,7,8]

9. 9.

   Maximal inspiratory pressure (PImax)

   • Change ≤ − 13 cmH2O [6,7,8]

10. x.

    Peak expiratory flow (PEF)

    • Change > x% or 60 L/min [9, 10]

11. 11.

    Diffusing capacity of the lungs for carbon monoxide (DLCO)

    • Change ≥ten% in DLCO [11, 12]

2 experienced pulmonologists (NA, AR) reviewed the included studies in consensus to place statistically significant and clinically important differences in pulmonary function. Results from articles included in the review were evaluated past all authors and categorized by study population, trunk positions studied, and outcome measures. Data from included studies was extracted by iv authors (NA, AR, SK, E-LM.) independently and in consultation when questions arose. The review was performed co-ordinate to the PRISMA guidelines [thirteen].

Although these are not interventional studies, strictly speaking, nosotros have chosen to assess them equally "before and after intervention," wherein the posture/position change is the maneuver of involvement. Level of evidence was assessed co-ordinate to the American Academy of Neurology (AAN) Classification of Evidence for therapeutic intervention [14]. Risk of bias was assessed co-ordinate to the Quality Assessment Tool for Before-After (Pre-Mail) Studies with No Command Group developed by the National Heart, Lung and Blood Found (NHLBI) of the US National Institutes of Health (NIH) [15]. This tool is comprised of 12 questions assessing various aspects of the quality of the written report. Two authors (E-LM, SK) independently scored each written report using the technique from Kunstler et al. [16]. Differences were resolved in consensus, in consultation with a tertiary author (YZ). The risk of bias was categorized as low (score 76–100%), moderate (26–75%) or high (0–25%).

Results

Studies included in the review

A total of 43 studies fully met inclusion criteria and were included in the review (Fig. i). All studies used either consecutive, convenience, or volunteer sampling to enroll healthy individuals or subjects with various medical weather condition. All studies provide Class Three level of show.

The protocols and level of bias in the various studies are shown in Table one and Boosted file i: Tabular array S1. Risk of bias was assessed as moderate in 41 studies and low in two. Quality problems were primarily related to sampling techniques for enrolling written report participants. All studies used non-random sampling. Some studies investigating healthy subjects included convenience samples of immature participants, mainly students. Only 7/43 studies reported sample size calculations required to achieve statistical power. In addition, the details of the intervention protocol were not clearly reported in some studies (Table 1) and due to the nature of the study assessors could non be blinded to patient position or outcomes from previous tests.

Tabular array 1 Study protocols

Full size table

A summary of study characteristics, including the positions studied, issue measures, and main results co-ordinate to the study population, is shown in Table ii. Out of 43 studies, 29 included healthy subjects, nine included patients with lung disease, four included patients with centre disease, vii included patients with SCI, three included patients with neuromuscular diseases, and four included patients with obesity. Additional file 2: Tabular array S2 summarizes only the statistically meaning findings for each relevant result variable, according to position, for each of the populations studied.

Table 2 Summary of study characteristics according to report population

Full size table

FVC

The association betwixt FVC and body position in salubrious subjects was investigated in 13 studies [3, 17,eighteen,19,20,21,22,23,24,25,26,27,28]. There was a clinical and statistically pregnant increase in FVC in sitting vs. supine positions [3, xviii, 22,23,24,25,26,27], in sitting vs. RSL and LSL [3, 21], continuing vs. supine [xix, 23], and standing vs. RSL and LSL [19]. In a smaller number of studies there was no modify between continuing and sitting [nineteen], sitting and supine [17, 21, 28] or sitting and RSL or LSL [21], and one study [22] constitute a decrease in FVC from sitting to standing that was statistically merely not clinically significant. Thus, in the bulk of studies the more upright position was associated with increased FVC.

Four studies included subjects with lung disease [29,thirty,31,32]. Amongst asthmatic patients in i study FVC increased significantly from supine to standing [30]; even so, at that place was no significant deviation betwixt continuing and sitting or betwixt sitting and supine, RSL, or LSL. Another report reported a statistically and clinically significant increase in FVC in standing vs. sitting, supine, RSL, and LSL and in sitting vs. supine, RSL and LSL [31]. Amid obese asthmatic patients [32], and among patients with chronic obstructive pulmonary disease (COPD) [29], no difference was found in FVC between standing and sitting.

Three studies included subjects with congestive heart failure (CHF) [18, 21, 27]. In one study, FVC was reported 200 ml higher in sitting vs. RSL and LSL [21], and in the other two studies FVC was higher in sitting vs. supine by 350–400 ml, which has clinical significance [eighteen, 27].

Half-dozen studies included patients with SCI [17, 33,34,35,36,37]. The effect of torso position on FVC depends on the level and extent of injury. Among those with cervical SCI, FVC was higher in the supine vs. sitting position [17, 33, 34]. Other studies [35,36,37] did not notice significant differences in FVC for patients with SCI in a pooled grouping of all levels of injury for these positions. However, in patients with cervical SCI, as well as those with thoracic injury in ane report [36], there was an increased FVC in the supine vs. sitting, while in those with thoracic or lumbar injury FVC was higher in the sitting position [37]. The differences did not always reach statistical significance. Nevertheless, it is important to note that in these debilitated patients with SCI, fifty-fifty a small modify in FVC is probably clinically significant.

3 studies evaluated patients with neuromuscular diseases [25, 34, 38]. In patients with myotonic dystrophy and in those with amyotrophic lateral sclerosis (ALS), there was a clinically and statistically pregnant subtract in FVC from sitting to supine [25, 34, 38]. In subjects with obesity (mean BMI 36.7) no significant deviation was reported between continuing and sitting [32].

FEV1

In healthy subjects, FEV1 was reported to exist college in sitting vs. supine [3, xviii, 22, 23, 26, 27, 39], in sitting vs. RSL and LSL [3, 19, 20], in standing vs. sitting [23], and in continuing vs. sitting, supine, RSL, and LSL [19]. Nonetheless, other studies [21, 24, 28, xl] did not find meaning difference for FEV1 between sitting and supine, RSL, and LSL. One study [22] reported a decrease of 120 ml in FEV1 from sitting to continuing, which is statistically but not clinically significant.

Among asthmatic patients, FEV1 was higher in the continuing vs. supine position, a statistically and clinically significant change; nonetheless, there was no significant divergence betwixt sitting vs. supine, RSL, and LSL positions [30]. Some other study in asthmatic patients reported FEV1 to exist college in standing vs. sitting, supine, RSL, and LSL, and in sitting  vs. supine, RSL and LSL [31]. Among obese asthmatic patients and those with COPD, at that place was no pregnant departure in FEV1 between continuing and sitting [29, 32].

In subjects with CHF, one report found a statistically and clinically significant increase in FEV1 in sitting vs. RSL and LSL, but no difference between sitting and supine [21], while two other studies reported college FEV1 in sitting vs. supine [xviii, 27].

In patients with SCI, FEV1 was recently reported to increase from sitting to supine [40]; nevertheless, other studies plant that the effect of position on FEV1 in those with SCI depends on the level and extent of injury. In one report among all subjects with SCI, FEV1 was not significantly influenced by moving from sitting to supine [35], but patients with cervical injuries showed a tendency for increased FEV1 in the supine vs. sitting position while those with thoracic injuries tended towards increased FEV1 in the sitting position. Forth the same vein, another study [36] found an increase is FEV1 in the sitting vs. the supine position in patients with lumbar injury while FEV1 was higher in the supine position for those with cervical spine or thoracic injuries. Although the differences betwixt positions were not statistically pregnant, the issue of level of injury was statistically and clinically pregnant.

In some other study [33], FEV1 was college in supine vs. sitting in patients with complete tetraplegia, while in patients with incomplete injury there was no significant difference between positions. Another group [37] reported no significant change in FEV1 between the sitting and supine positions for a pooled group of patients with SCI, simply in the subgroup of patients with incomplete motor injury and in those with incomplete thoracic motor injury at that place was a decrease in the supine position.

In patients with myotonic dystrophy, FEV1 decreased from sitting to supine [38]. Among those with obesity, FEV1 was higher in sitting vs. supine both before and after bariatric surgery [41]. In another study among obese patients, there was no difference in FEV1 between standing and sitting [32].

FEV1/FVC

Vii studies compared FEV1/FVC for different body positions in good for you subjects [18, 19, 23, 24, 27, 28, 42]. In several studies, FEV1/FVC was reported to be college in sitting vs. supine [23, 28], in sitting vs. LSL [19], and in standing vs. supine, RSL, and LSL [19]; nonetheless, FEV1/FVC was > seventy% in all trunk positions then the difference was not clinically meaning. Other studies found no difference between sitting and supine [18, 24, 27] or standing, sitting, and supine [42].

Among subjects with asthma, CHF, and obesity no statistically significant deviation in FEV1/FVC was found betwixt the different trunk postures [eighteen, 27, 32, 42].

Vital capacity

The effect of body position on vital capacity was evaluated in six studies of healthy subjects [21, 24, 28, 39, 43, 44]. In about studies no difference was reported between sitting and supine [21, 24, 28, 43] or betwixt sitting and RSL or LSL [21]. Ane study [39] found that VC was higher in the sitting vs. supine position. However, another study [44] establish that VC was higher in the supine vs. sitting position, but only in females.

In patients with CHF, VC was reported to be higher in sitting vs. supine in i study [27] while another written report found no statistically significant difference between these positions [21]. In patients with spinal string injury, VC was higher in the supine vs. sitting position [xl]. In subjects with obesity, no deviation in VC was reported between the sitting and supine positions [41, 43].

PEF

PEF in different torso positions was evaluated in 13 studies [3, 22,23,24, 31, 33, 45,46,47,48,49,50,51]. 8 studies evaluated but healthy adults [3, 22,23,24, 45, 48, l, 51], three evaluated healthy subjects and patients with COPD or asthma [31, 46, 49], one included adult cystic fibrosis patients [47], and one included subjects with SCI [33]. Nine studies that compared standing or sitting positions vs. supine or RSL and LSL found college PEF in continuing and sitting [3, 22,23,24, 31, 45,46,47,48]. Iii of six studies comparison the standing and sitting positions found higher PEF in continuing [46, 50, 51] and ane reported higher PEF in sitting [22]. Yet, it is most likely that none of the differences reported in PEF are clinically pregnant. In SCI patients with complete tetraplegia PEF was found to be 12% higher in the supine vs. sitting position [33].

FRC

FRC was evaluated using helium dilution in v studies [27, 41, 43, 52, 53]. Amidst healthy subjects, FRC was higher in standing [53] and in sitting [27, 43] vs. supine, with the differences reaching statistical and clinical significance. Notwithstanding, the difference in sitting vs. supine was not meaning amidst patients with obesity (mean BMI 44–45) [41, 43] or CHF [27], and was higher in sitting vs. supine in patients after bariatric surgery (mean BMI 31) [41]. Another study [52] involving subjects with mild-to-moderate obesity (hateful BMI 32), reported that FRC was significantly higher both statistically and clinically in sitting vs. supine.

Total lung capacity

Two studies that evaluated TLC using helium dilution in salubrious subjects [43] and in subjects with obesity [41, 43] found no statistically meaning difference between the sitting and supine positions.

Residual volume

Two studies that evaluated RV using helium dilution in healthy subjects [43] and those with obesity [41, 43] establish no statistically meaning divergence between sitting and supine.

PEmax

Six studies investigated the clan between torso position and PEmax in good for you subjects [three, 28, 39, 46, 54, 55]. PEmax was higher in continuing vs. supine, in continuing vs. sitting and RSL, in sitting vs. supine [54], and in sitting vs. supine and RSL [46]; however, the differences reported in those studies were not clinically meaning. Other studies establish no departure in PEmax between sitting and supine [28, 39], or between sitting, supine, RSL, and LSL [3, 55].

In COPD patients, PEmax was college in standing or sitting vs. supine or RSL [46], and was college in standing and sitting vs. RSL in patients with cystic fibrosis [47]. The differences were non clinically meaning.

In subjects with SCI, PEmax was significantly higher in sitting vs. supine for all subjects, and for patients with motor complete injury or incomplete cervical motor injury [37].

PImax

In healthy subjects, PImax was improved in sitting vs. supine in ii studies [3, 54]. However, other studies found no divergence in PImax in sitting vs. supine [28, 39, 55], or sitting vs. RSL and LSL [iii, 55]. In subjects with chronic SCI, no pregnant modify was seen in PImax between sitting and supine, with the exception of a subgroup of patients with complete thoracic motor paresis where there was statistically and clinically meaning improvement in sitting [37].

DLCO

Seven studies evaluated the effect of trunk position on diffusion capacity; six included good for you subjects [18, 20, 21, 24, 56, 57], 3 included patients with CHF [eighteen, 21, 58], and one included COPD patients [57].

Amidst healthy subjects, ii studies [24, 56] establish statistically and clinically significant improvement in DLCO in supine vs. sitting and one [57] found a trend towards increased DLCO in supine vs. sitting, however this departure did not reach statistical significance. 1 written report [18] found DLCO to be higher in the sitting vs. supine positions while another written report found no difference in DLCO between these positions [21]. One written report [21] reported higher DLCO in sitting vs. side lying while another study [20] institute no deviation between these positions. In COPD patients, no statistically pregnant modify in DLCO was constitute between the sitting and the supine position [57].

3 studies investigated diffusion chapters in patients with CHF [18, 21, 58]. I study [58] establish that postural changes from the supine to sitting positions induced different responses in diffusion capacity. In some patients diffusion capacity improved in the sitting position and others showed no change or a reject. On the average no statistically significant difference was found betwixt the 2 positions. The authors attributed the difference in responses to variations in pulmonary circulation pressures. Another written report [18] found no significant difference in diffusion capacity between the sitting and the supine positions. Side-lying was reported to reduce DLCO in comparison to sitting in the third written report [21].

Discussion

Almost studies in this systematic review of 43 papers evaluating the effect of body position on pulmonary function establish that pulmonary function improved with more erect posture in both good for you subjects and those with lung disease, heart disease, neuromuscular diseases, and obesity. In patients with SCI, the outcome is more than complex and depends on the severity and level of injury. In contrast, diffusion capacity, as assessed by DLCO, increases in the supine position in salubrious subjects while the effect in CHF patients is thought to depend upon pulmonary circulation pressure.

Decreased FVC in more than recumbent positions may reflect both increased thoracic blood volume due to gravitational facilitation of venous render, which is more of import in patients with eye failure, also every bit cephalic displacement of the diaphragm due to abdominal pressure level in the recumbent positions, which is more important in obese subjects [59]. In side-lying positions, fifty-fifty though only the dependent hemi-diaphragm is displaced, the issue on FVC appears to be similar to that observed in a supine position [59]. Other factors that may contribute to lower FVC values in side-lying positions include increased airway resistance and decreased lung compliance secondary to anatomical differences betwixt the left and correct lungs, as well as shifting of the mediastinal structures [20].

FEV1 was also higher in erect positions. Recumbent positions limit expiratory volumes and period, which may reflect an increase in airway resistance, a decrease in elastic recoil of the lung, or decreased mechanical advantage of forced expiration, presumably affecting the large airways [xx]. In asthmatic patients the increase in FVC while standing might exist due to the increased diameter of the airways in this position [30].

In patients with CHF the lungs are stiff and heavy, and the centre is large and heavy, increasing the negative furnishings of lung-heart interdependence [60]. As cardiac dimension increases, lung book, mechanical function, and diffusion capacity subtract [61, 62]; thus, the heart weighs on the diaphragm while sitting and on one of the lungs while in a side-lying position. This influences the ability of the lungs to aggrandize laterally but allows the diaphragm to descend and the lungs to expand inferiorly. In side-lying positions, the heart weighs on ane lung, compressing both the airways and lung parenchyma, leading to a reduction in FEV1 and FVC due to airway pinch [21]. Both rubberband (reduced lung compliance) and resistive loads are simultaneously increased in the supine position in CHF patients [63].

Changes in FVC from the sitting to supine positions may reflect diaphragm strength/paralysis. FVC is thus an of import clinical tool for cess of diaphragmatic weakness in patients with neuromuscular diseases [64]. In patients with ALS, supine FVC is a test of diaphragmatic weakness [65] that predicts orthopnea [25] and prognosis for survival [66, 67]. The American Academy of Neurology has concluded that in ALS patients, supine FVC is probably more constructive than erect FVC in detecting diaphragm weakness and correlates better with symptoms of hypoventilation [68].

In patients with cervical SCI (tetraplegia), FVC and FEV1 increase in the supine vs. sitting position. The diaphragm increases its inspiratory circuit in the supine position because its musculus fibers are longer at end expiration, and they operate at a more than effective betoken of their length-tension bend [69,lxx,71]. This machinery is especially of import in patients for whom the diaphragm is the primary muscle for animate, since their intercostal and abdominal muscles are inactive due to SCI.

FRC was reported to increment in upright positions in healthy subjects [27, 43, 53] and in patients with mild-to-moderate obesity [41, 52]. Changing from a supine to an upright position increases FRC due to reduced pulmonary blood book and the descent of the diaphragm. This may modify the point in which tidal breathing occurs in the volume-pressure curve, which leads to increased lung compliance, and thus an identical pressure alter would produce a greater inspired volume if in that location is no change in respiratory drive [53]. All the same, among patients with CHF, no difference in FRC between sitting and supine was reported [27]. In heart failure, reduction in lung compliance in the supine position might reduce the passive modify in lung book, but FRC may be sustained in a higher place relaxation book by an adjustment in respiratory muscle or glottal activity [27]. Among patients with obesity the sitting FRC was less than in healthy subjects merely at that place was no further decrease in the supine position [43].

PEF, PEmax, and PImax were found to increase in upright positions in healthy subjects [3, 23, 24, 46, 48, 50, 51] and in those with lung diseases [31, 46, 47]. This may exist related to changes in lung volumes with positions.

Standing and sitting have been shown to lead to the highest lung volumes [72, 73]. At higher lung volumes the rubberband recoil of the lungs and the chest wall is greater. In addition, the expiratory muscles are at a more optimal region of the length-tension curve and thus are capable of generating higher intrathoracic pressure, potentially generating higher expiratory pressures and pushing air through narrow airways at high speed, which results in higher PEmax, PEF, and FEV1. As lung volumes decrease, muscle length becomes less optimal, which results in lower PEmax in sitting, compared to the standing position, and even lower in more recumbent positions. The modify in PEmax influences PEF [46].

When standing, gravity pulls the mediastinal and abdominal structures down, creating more space in the thoracic crenel, which allows further expansion of the lungs and greater lung volumes [74]. This, along with the subtract in compression on the lung bases, allows alveoli to recruit and increases lung compliance. The inspiratory muscles tin can aggrandize even more, which allows the diaphragm to continue contracting downwards, thus increasing lung volumes [46].

Sitting oft leads to the somewhat reduced lung volumes compared with standing. This can be explained past several mechanisms. First, in sitting, abdominal organs are college, interfering with diaphragmatic movement, thus enabling smaller inspiration. 2nd, the abdominal muscles are in a less optimal signal in the length-tension curve, since the combination of hip flexion and higher position of the abdominal contents exert upwards pressure. Third, the back of the chair may limit thoracic expansion. These iii factors explain a slightly lower PEmax and PEF in sitting vs. standing [46].

Diaphragmatic force is negatively affected past the supine position, and intrathoracic blood volume is increased. These factors atomic number 82 to decreased PEmax and PEF in the supine position [3].

In side-lying positions (RSL or LSL), when the bed is flat, the abdominal contents autumn forward. The dependent hemi-diaphragm is stretched to a practiced length for tension generation, while the nondependent hemi-diaphragm is more flattened. Changes in lung volumes may thus balance themselves out due to a ameliorate diaphragmatic contraction merely decreased infinite in the thorax [46].

The decreased PImax observed in the supine position could be related to diaphragm overload by abdominal content deportation during maximal inspiratory attempt, which could offset improved diaphragm position on the length-tension curve. In improver, the length of all other inspiratory muscles may go less optimal in supine position [75].

In patients with cervical spinal cord injury and loftier tetraplegia, PEF was found to be higher in the supine vs. sitting position [33] respective to the increase in FVC and FEV1 in the supine position.

In healthy subjects, nigh studies showed an increase in DLCO in supine vs. sitting [24, 56, 57]. This improvement is attributed to the moderate increment in alveolar blood volume in the supine position due to recruitment of lung capillary bed on transition from upright to supine. Age may attenuate this increase [76]. This may explicate why a study that included participants with a hateful age of 61 [21] found no divergence in DLCO between sitting and supine.

In side-lying positions, the heart weighs on one lung, compressing both airways and lung parenchyma, reducing alveolar blood volume, and causing ventilation/ perfusion mismatch. Those furnishings acquired reduction of diffusion capacity in the side-lying positions [21].

In COPD patients, at that place was no change in DLCO betwixt sitting and supine [57]. This might be related to reduced FVC and alveolar damage in these patients. These furnishings might accept negative affect on diffusion capacity, opposing the positive effect of the increase in blood book in the alveoli [57].

In patients with CHF, different patterns of the effect of posture on DLCO were observed [58]. The change in DLCO was probably related to the change in alveolar blood volume, most likely due to differences in pulmonary artery pressure and heart dimensions [58].

Limitations of the study

There are a few limitations to this review. First, the level of testify of the studies is relatively low. However, in this type of inquiry, due to the nature of the populations studied and the interventions applied, it is incommunicable to perform a randomized control study. Second, about studies were performed on a small number of subjects and all studies used either consecutive, convenience, or volunteer sampling. The review included simply adult subjects and it is therefore non possible to generalize the results to children and adolescents. Finally, research protocols varied between studies and detailed information near protocols were often missing. Patient cooperation during lung function testing strongly influences results. This may explain contradictory results obtained in some cases. Studies that included subjects older than 60 years did non mention the cognitive function of participants, a cistron that may influence patient cooperation.

Further enquiry in this field is needed, including studies designed to evaluate lung function in a larger number of healthy participants as well as in individuals with a variety of medical conditions. At that place is also a need to use a standardized protocol including randomization of postures and times between tests (due east.g. for wash-out of inhaled gasses or redistribution of claret volume) in different positions to enable a improve comparison of outcomes.

Conclusions

When performing pulmonary function tests, trunk position plays a role in its influence over examination results. As seen in this review, a alter in body position may have varying implications depending on the patient populations. American Thoracic Society (ATS) guidelines [2] recommend performing PFTs in the sitting or standing position, but the sitting position is normally preferred. The norms of those functions according to gender and age were established from tests performed in this position. This review suggests that for virtually of the subjects this is the preferred position for the test; however, clinicians should consider performing PFTs in other positions in selected patients. In patients with SCI, testing also in the supine position may provide important information. In patients with neuromuscular disorders, performing PFTs in the supine position may help to assess diaphragmatic function.

Positioning plays an important role in maximizing respiratory function when treating patients with diverse problems and diseases and information technology is important to know the implications of each position on the respiratory system of a specific patient. Understanding the influence of trunk position tin give healthcare professionals better knowledge of optimal positions for patients with different diseases.

Abbreviations

AAN:

American Academy of Neurology

ALS:

Amyotrophic lateral sclerosis

ATS:

American Thoracic Gild

CHF:

Congestive heart failure

COPD:

Chronic obstructive pulmonary affliction

DLCO:

Diffusing capacity of the lungs for carbon monoxide

ERS:

European Respiratory Social club

FEV1:

Forced expiratory volume in 1 s

FRC:

Functional residual capacity

FVC:

Forced vital capacity

LSL:

Left side lying

PEF:

Peak expiratory period

PEmax:

Maximal expiratory pressure

PFT:

Pulmonary role examination

PImax:

Maximal inspiratory pressure

RSL:

Right side lying

RV:

Residual volume

SCI:

Spinal cord injury

TLC:

Total lung chapters

VC:

Vital chapters

References

1. Crapo RO. Pulmonary-function testing. N Engl J Med. 1994;331(1):25–30.

   CAS  Commodity  Google Scholar

2. Miller MR, Crapo R, Hankinson J, et al. General considerations for lung office testing. Eur Respir J. 2005;26(1):153–61.

   CAS  Article  Google Scholar

3. Meysman K, Vincken Westward. Event of body posture on spirometric values and upper airway obstruction indices derived from the flow-volume loop in immature nonobese subjects. Chest. 1998;114(4):1042–7.

   CAS  Article  Google Scholar

4. Pellegrino R, Viegi Thousand, Brusasco V, et al. Interpretative strategies for lung part tests. Eur Respir J. 2005;26(5):948–68.

   CAS  Article  Google Scholar

5. Wanger J, Clausen JL, Coates A, et al. Standardisation of the measurement of lung volumes. Eur Respir J. 2005;26(3):511–22.

   CAS  Article  Google Scholar

6. Goswami R, Guleria R, Gupta AK, et al. Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves' affliction and their reversibility with carbimazole therapy. Eur J Endocrinol. 2002;147(3):299–303.

   CAS  Article  Google Scholar

7. Keenan SP, Alexander D, Road JD, Ryan CF, Oger J, Wilcox PG. Ventilatory musculus strength and endurance in myasthenia gravis. Eur Respir J. 1995;8(7):1130–5.

   CAS  Article  Google Scholar

8. Nava S, Crotti P, Gurrieri 1000, Fracchia C, Rampulla C. Effect of a beta 2-agonist (broxaterol) on respiratory musculus strength and endurance in patients with COPD with irreversible airway obstruction. Chest. 1992;101(1):133–forty.

   CAS  Article  Google Scholar

9. Quanjer PH, Lebowitz MD, Gregg I, Miller MR, Pedersen OF. Peak expiratory flow: conclusions and recommendations of a working Political party of the European Respiratory Society. Eur Respir J Suppl. 1997;24:2s–8s.

   CAS  PubMed  Google Scholar

10. Global initiative for asthma (GINA): Global strategy for asthma management and prevention (2018 update). 2018. file:///C:/Users/owner/Downloads/wms-GINA-2018-report-V1.3–002.pdf. Accessed 29 May 2018.

    Google Scholar

11. Graham BL, Brusasco V, Burgos F, et al. 2022 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J. 2017;49(1). https://doi.org/10.1183/13993003.00016-2016.

    Article  Google Scholar

12. Hathaway EH, Tashkin DP, Simmons MS. Intraindividual variability in serial measurements of DLCO and alveolar volume over one twelvemonth in viii good for you subjects using iii contained measuring systems. Am Rev Respir Dis. 1989;140(6):1818–22.

    CAS  Article  Google Scholar

13. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(seven):e1000097.

    Article  Google Scholar

14. Gronseth GS, Woodroffe LM, Getchuis TSD. Clinical exercise guideline process manual. 2011. http://tools.aan.com/globals/axon/assets/9023.pdf. Accessed 29 May 2018.

15. Quality cess tool for before-after (pre-mail) studies with no control group. 2014. https://www.nhlbi.nih.gov/wellness-topics/study-quality-assessment-tools. Accessed 12 Aug 2018.

16. Kunstler BE, Melt JL, Freene N, et al. Physiotherapist-led physical activeness interventions are efficacious at increasing physical action levels: a systematic review and meta-analysis. Clin J Sport Med. 2018;28(three):304–15.

    Article  Google Scholar

17. Ben-Dov I, Zlobinski R, Segel MJ, Gaides M, Shulimzon T, Zeilig G. Ventilatory response to hypercapnia in C(5-8) chronic tetraplegia: the outcome of posture. Arch Phys Med Rehabil. 2009;90(8):1414–7.

    Article  Google Scholar

18. Ceridon ML, Morris NR, Olson TP, Lalande S, Johnson BD. Effect of supine posture on airway blood menses and pulmonary function in stable heart failure. Respir Physiol Neurobiol. 2011;178(two):269–74.

    Commodity  Google Scholar

19. Ganapathi LV, Vinoth S. The estimation of pulmonary functions in various body postures in normal subjects. Int J Advances Med. 2015;2(three):250–4 http://www.ijmedicine.com/index.php/ijam/commodity/view/360. Accessed 29 May 2018.

    Article  Google Scholar

20. Manning F, Dean E, Ross J, Abboud RT. Effects of side lying on lung role in older individuals. Phys Ther. 1999;79(v):456–66.

    CAS  PubMed  Google Scholar

21. Palermo P, Cattadori G, Bussotti Thousand, Apostolo A, Contini Grand, Agostoni P. Lateral decubitus position generates discomfort and worsens lung role in chronic heart failure. Chest. 2005;128(3):1511–6.

    Commodity  Google Scholar

22. Patel AK, Thakar HM. Spirometric values in sitting, standing, and supine position. Lung Pulm Resp Res. 2015;2(1):00026 http://medcraveonline.com/JLPRR/JLPRR-02-00026.php. Accessed 29 May 2018.

    Google Scholar

23. Saxena J, Gupta S, Saxena Southward. A study of change of posture on the pulmonary function tests : can it help COPD patients? Indian J Community Health. 2006;xviii(one):10–2. http://world wide web.iapsmupuk.org/journal/alphabetize.php/IJCH/commodity/view/108. Accessed 29 May 2018.

24. Stewart IB, Potts JE, McKenzie DC, Coutts KD. Consequence of torso position on measurements of improvidence chapters after exercise. Br J Sports Med. 2000;34(half-dozen):440–4.

    CAS  Article  Google Scholar

25. Varrato J, Siderowf A, Damiano P, Gregory Due south, Feinberg D, McCluskey L. Postural change of forced vital capacity predicts some respiratory symptoms in ALS. Neurology. 2001;57(two):357–9.

    CAS  Article  Google Scholar

26. Vilke GM, Chan TC, Neuman T, Clausen JL. Spirometry in normal subjects in sitting, decumbent, and supine positions. Respir Care. 2000;45(4):407–x.

    CAS  PubMed  Google Scholar

27. Yap JC, Moore DM, Cleland JG, Pride NB. Effect of supine posture on respiratory mechanics in chronic left ventricular failure. Am J Respir Crit Care Med. 2000;162(4 Pt 1):1285–91.

    CAS  Article  Google Scholar

28. Tsubaki A, Deguchi S, Yoneda Y. Influence of posture on respiratory function and respiratory muscle strength in normal subjects. J Phys Ther Sci. 2009;21(ane):71–four https://www.jstage.jst.get.jp/commodity/jpts/21/1/21_1_71/_article. Accessed 29 May 2018.

    Article  Google Scholar

29. De S. Comparison of spirometric values in sitting versus standing position amongst patients with obstructive lung part. Indian J Allergy Asthma Immunol. 2012;26(2):86–viii http://medind.nic.in/iac/t12/i2/iact12i2p86.pdf. Accessed 29 May 2018.

    Article  Google Scholar

30. Melam GR, Buragadda Due south, Alhusaini A, Alghamdi MA, Alghamdi MS, Kaushal P. Effect of unlike positions on FVC and FEV1 measurements of asthmatic patients. J Phys Ther Sci. 2014;26(4):591–3.

    Commodity  Google Scholar

31. Mohammed J, Abdulateef A, Shittu A, Sumaila FG. Issue of different body positioning on lung function variables among patients with bronchial asthma. Arch Physiother Global Res. 2017;21(3):seven–12. http://apgr.wssp.edu.pl/wp-content/uploads/2017/12/APGR-21-iii-A.pdf. Accessed 29 May 2018.

32. Razi E, Moosavi GA. The effect of positions on spirometric values in obese asthmatic patients. Iran J Allergy Asthma Immunol. 2007;half-dozen(three):151–4.

    PubMed  Google Scholar

33. Linn WS, Adkins RH, Gong H Jr, Waters RL. Pulmonary part in chronic spinal cord injury: a cross-sectional survey of 222 southern California adult outpatients. Curvation Phys Med Rehabil. 2000;81(6):757–63.

    CAS  Article  Google Scholar

34. Park JH, Kang SW, Lee SC, Choi WA, Kim DH. How respiratory muscle forcefulness correlates with cough capacity in patients with respiratory muscle weakness. Yonsei Med J. 2010;51(3):392–7.

    Commodity  Google Scholar

35. Baydur A, Adkins RH, Milic-Emili J. Lung mechanics in individuals with spinal cord injury: effects of injury level and posture. J Appl Physiol. 2001;90(2):405–11.

    CAS  Commodity  Google Scholar

36. Kim 1000-K, Hwangbo G. The effect of position on measured lung function in patients with spinal string injury. J Physical Therapy Sci. 2012;24(8):655–7 https://www.jstage.jst.become.jp/commodity/jpts/24/8/24_JPTS-2012-029/_article. Accessed 29 May 2018.

37. Terson de Paleville DG, Sayenko DG, Aslan SC, Folz RJ, McKay WB, Ovechkin AV. Respiratory motor function in seated and supine positions in individuals with chronic spinal string injury. Respir Physiol Neurobiol. 2014;203:nine–14.

    Article  Google Scholar

38. Poussel Chiliad, Kaminsky P, Renaud P, Laroppe J, Pruna 50, Chenuel B. Supine changes in lung function correlate with chronic respiratory failure in myotonic dystrophy patients. Respir Physiol Neurobiol. 2014;193:43–51.

    Article  Google Scholar

39. Naitoh Southward, Tomita K, Sakai K, Yamasaki A, Kawasaki Y, Shimizu E. The effect of body position on pulmonary function, breast wall motion, and discomfort in young good for you participants. J Manipulative Physiol Ther. 2014;37(9):719–25.

    Article  Google Scholar

40. Miccinilli Due south, Morrone M, Bastianini F, et al. Optoelectronic plethysmography to evaluate the result of posture on breathing kinematics in spinal cord injury: a cross exclusive study. Eur J Phys Rehabil Med. 2016;52(1):36–47.

    PubMed  Google Scholar

41. Sebbane M, El Kamel M, Millot A, et al. Effect of weight loss on postural changes in pulmonary part in obese dubjects: a longitudinal study. Respir Care. 2015;threescore(7):992–9.

    Commodity  Google Scholar

42. Myint WW, Htay MNN, Soe HHK, et al. Result of trunk positions on lungs volume in asthmatic patients: a cross-sectinal study. J Adv Med Pharma Sci. 2017;13(4):ane–6 http://world wide web.journalrepository.org/media/journals/JAMPS_36/2017/Jun/Myint1342017JAMPS33901.pdf. Accessed 29 May 2018.

    Google Scholar

43. Watson RA, Pride NB. Postural changes in lung volumes and respiratory resistance in subjects with obesity. J Appl Physiol (1985). 2005;98(2):512–7.

    CAS  Article  Google Scholar

44. Roychowdhury P, Pramanik T, Prajapati R, Pandit R, Singh S. In health--vital capacity is maximum in supine position. Nepal Med Coll J. 2011;13(two):131–2.

    CAS  PubMed  Google Scholar

45. Antunes BO, de Souza HC, Gianinis HH, Passarelli-Amaro RC, Tambascio J, Gastaldi Air-conditioning. Superlative expiratory flow in healthy, young, not-agile subjects in seated, supine, and prone postures. Physiother Theory Pract. 2016;32(6):489–93.

    Article  Google Scholar

46. Badr C, Elkins MR, Ellis ER. The effect of body position on maximal expiratory pressure level and catamenia. Aust J Physiother. 2002;48(two):95–102.

    Commodity  Google Scholar

47. Elkins MR, Alison JA, Bye PT. Effect of body position on maximal expiratory pressure level and flow in adults with cystic fibrosis. Pediatr Pulmonol. 2005;xl(5):385–91.

    Article  Google Scholar

48. Gianinis HH, Antunes BO, Passarelli RC, Souza HC, Gastaldi Air conditioning. Effects of dorsal and lateral decubitus on peak expiratory flow in healthy subjects. Braz J Phys Ther. 2013;17(5):435–41.

    Commodity  Google Scholar

49. McCoy EK, Thomas JL, Sowell RS, et al. An evaluation of peak expiratory flow monitoring: a comparing of sitting versus standing measurements. J Am Board Fam Med. 2010;23(2):166–seventy.

    Article  Google Scholar

50. Ottaviano G, Scadding GK, Iacono 5, Scarpa B, Martini A, Lund VJ. Summit nasal inspiratory period and acme expiratory catamenia. Upright and sitting values in an adult population. Rhinology. 2016;54(ii):160–3.

    Article  Google Scholar

51. Wallace JL, George CM, Tolley EA, et al. Peak expiratory menstruation in bed? A comparison of 3 positions. Respir Care. 2013;58(3):494–7.

    PubMed  Google Scholar

52. Benedik PS, Baun MM, Keus L, et al. Effects of body position on resting lung volume in overweight and mildly to moderately obese subjects. Respir Care. 2009;54(3):334–nine.

    PubMed  Google Scholar

53. Chang AT, Boots RJ, Dark-brown MG, Paratz JD, Hodges PW. Ventilatory changes following head-up tilt and standing in good for you subjects. Eur J Appl Physiol. 2005;95(v–6):409–17.

    Commodity  Google Scholar

54. Costa R, Almeida North, Ribeiro F. Body position influences the maximum inspiratory and expiratory rima oris pressures of young healthy subjects. Physiotherapy. 2015;101(2):239–41.

    Commodity  Google Scholar

55. Ogiwara Southward, Miyachi T. Effect of posture on ventilatory muscle strength. J Phys Ther Sci. 2002;14(1):1–5. https://world wide web.jstage.jst.go.jp/article/jpts/14/ane/14_1_1/_pdf/-char/en. Accessed 29 May 2018.

    Article  Google Scholar

56. Peces-Barba G, Rodriguez-Nieto MJ, Verbanck S, Paiva M, Gonzalez-Mangado North. Lower pulmonary diffusing chapters in the decumbent vs. supine posture. J Appl Physiol (1985). 2004;96(5):1937–42.

    CAS  Article  Google Scholar

57. Terzano C, Conti V, Petroianni A, Ceccarelli D, De Vito C, Villari P. Result of postural variations on carbon monoxide diffusing capacity in salubrious subjects and patients with chronic obstructive pulmonary disease. Respiration. 2009;77(ane):51–7.

    Commodity  Google Scholar

58. Faggiano P, D'Aloia A, Simoni P, et al. Furnishings of body position on the carbon monoxide diffusing chapters in patients with chronic heart failure: relation to hemodynamic changes. Cardiology. 1998;89(one):1–7.

    CAS  Article  Google Scholar

59. Behrakis PK, Baydur A, Jaeger MJ, Milic-Emili J. Lung mechanics in sitting and horizontal body positions. Chest. 1983;83(4):643–half dozen.

    CAS  Article  Google Scholar

60. Agostoni PG, Marenzi GC, Sganzerla P, et al. Lung-heart interaction as a substrate for the improvement in practise capacity after body fluid volume depletion in moderate congestive heart failure. Am J Cardiol. 1995;76(11):793–8.

    CAS  Article  Google Scholar

61. Agostoni PG, Cattadori Grand, Guazzi Thou, Palermo P, Bussotti M, Marenzi Grand. Cardiomegaly equally a possible cause of lung dysfunction in patients with middle failure. Am Center J. 2000;140(five):e24.

    CAS  Article  Google Scholar

62. Hosenpud JD, Stibolt TA, Atwal K, Shelley D. Abnormal pulmonary function specifically related to congestive middle failure: comparing of patients before and subsequently cardiac transplantation. Am J Med. 1990;88(5):493–vi.

    CAS  Article  Google Scholar

63. Nava S, Larovere MT, Fanfulla F, Navalesi P, Delmastro M, Mortara A. Orthopnea and inspiratory try in chronic heart failure patients. Respir Med. 2003;97(6):647–53.

    CAS  Commodity  Google Scholar

64. Fromageot C, Lofaso F, Annane D, et al. Supine fall in lung volumes in the assessment of diaphragmatic weakness in neuromuscular disorders. Arch Phys Med Rehabil. 2001;82(1):123–8.

    CAS  Commodity  Google Scholar

65. Lechtzin N, Wiener CM, Shade DM, Clawson 50, Diette GB. Spirometry in the supine position improves the detection of diaphragmatic weakness in patients with amyotrophic lateral sclerosis. Chest. 2002;121(two):436–42.

    Article  Google Scholar

66. Baumann F, Henderson RD, Morrison SC, et al. Utilize of respiratory office tests to predict survival in amyotrophic lateral sclerosis. Amyotroph Lateral Scler. 2010;11(i–2):194–202.

    Article  Google Scholar

67. Schmidt EP, Drachman DB, Wiener CM, Clawson Fifty, Kimball R, Lechtzin N. Pulmonary predictors of survival in amyotrophic lateral sclerosis: use in clinical trial design. Muscle Nerve. 2006;33(1):127–32.

    Article  Google Scholar

68. Miller RG, Jackson CE, Kasarskis EJ, et al. Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: drug, nutritional, and respiratory therapies (an show-based review): report of the quality standards Subcommittee of the American Academy of Neurology. Neurology. 2009;73(xv):1218–26.

    CAS  Article  Google Scholar

69. Fugl-Meyer AR. Furnishings of respiratory muscle paralysis in tetraplegic and paraplegic patients. Scand J Rehabil Med. 1971;3(4):141–fifty.

    CAS  PubMed  Google Scholar

70. Fugl-Meyer AR, Grimby M. Respiration in tetraplegia and in hemiplegia: a review. Int Rehabil Med. 1984;6(4):186–90.

    CAS  Commodity  Google Scholar

71. Huldtgren AC, Fugl-Meyer AR, Jonasson East, Bake B. Ventilatory dysfunction and respiratory rehabilitation in mail service-traumatic quadriplegia. Eur J Respir Dis. 1980;61(six):347–56.

    CAS  PubMed  Google Scholar

72. Wade OL, Gilson JC. The effect of posture on diaphragmatic movement and vital capacity in normal subjects with a note on spirometry equally an aid in determining radiological chest volumes. Thorax. 1951;six(2):103–26.

    CAS  Article  Google Scholar

73. Moreno F, Lyons HA. Effect of body posture on lung volumes. J Appl Physiol. 1961;16:27–9.

    CAS  Article  Google Scholar

74. Castile R, Mead J, Jackson A, Wohl ME, Stokes D. Effects of posture on flow-book bend configuration in normal humans. J Appl Physiol Respir Environ Exerc Physiol. 1982;53(five):1175–83.

    CAS  PubMed  Google Scholar

75. Segizbaeva MO, Pogodin MA, Aleksandrova NP. Furnishings of body positions on respiratory muscle activation during maximal inspiratory maneuvers. Adv Exp Med Biol. 2013;756:355–63.

    CAS  Article  Google Scholar

76. Chang SC, Chang Hullo, Liu SY, Shiao GM, Perng RP. Effects of torso position and age on membrane diffusing chapters and pulmonary capillary claret volume. Chest. 1992;102(1):139–42.

    CAS  Article  Google Scholar

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Acknowledgements

The authors wish to thank Prof. Ora Paltiel, a specialist in Internal Medicine, Hematology, and Oncology who also holds a doctorate in Epidemiology and Biostatistics, for her invaluable assistance in selecting the optimal tools for assessment of the quality of evidence and potential for bias of studies included in this systematic review.

The authors wish to thank Shifra Fraifeld, a medical center-based medical writer and editor, for her editorial contribution during manuscript preparation.

Author information

Author notes

1. Shikma Katz and Nissim Arish contributed as to this work.

Affiliations

1. Chronic Ventilator-Dependent Segmentation, Herzog Medical Center, POB 3900, Jerusalem, Israel

   Shikma Katz, Yacov Zaltzman & Esther-Lee Marcus

2. Pulmonary Institute, Shaare Zedek Medical Center, POB 3235, Jerusalem, State of israel

   Nissim Arish & Ariel Rokach

3. Recanati Schoolhouse for Community Health Professions, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel

   Shikma Katz

4. Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel

   Nissim Arish, Ariel Rokach & Esther-Lee Marcus

Contributions

SK, Due east-LM, NA, AR contributed to the study concept and design. SK, E-LM, NA, AR, YZ contributed to data acquisition and analysis, and interpretation of the data. The primary literature search was conducted past SK and E-LM. SK and E-LM drafted the manuscript. SK, E-LM, NA, AR, YZ critically reviewed and revised the manuscript for intellectual content. All authors reviewed the concluding version of the manuscript prior to submission and all take responsibility for the integrity of the research process and findings. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ariel Rokach.

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Ethics approval and consent to participate

Not applicable – systematic review.

Consent for publication

Not applicative.

Competing interests

The authors declare that they have no competing interests.

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Boosted files

Additional file 1:

Table S1. Scoring for papers included in the systematic review based on the Quality Cess Tool for Before-After (Pre-Post) Studies with No Control Group of the National Heart, Lung and Blood Institute [3, xv,16,17,eighteen,nineteen,20,21,22,23,24,25,26,27,28,29,thirty,31, 33,34,35,36,37,38,39,forty,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58]. (DOCX 63 kb)

Additional file two:

Table S2. Statistically significant differences in pulmonary role between the various body positions [3, 17,18,19,twenty,21,22,23,24,25,26,27,28, 30, 31, 33, 34, 37,38,39,forty,41, 43,44,45,46,47,48, 50,51,52,53,54, 56]. (DOCX 104 kb)

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Katz, South., Arish, N., Rokach, A. et al. The upshot of body position on pulmonary role: a systematic review. BMC Pulm Med 18, 159 (2018). https://doi.org/10.1186/s12890-018-0723-4

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• Received: 06 May 2017

• Accepted: 17 September 2018

• Published: 11 October 2018

• DOI : https://doi.org/10.1186/s12890-018-0723-4

Keywords

• Trunk position
• Lung volume
• Physical therapy
• Positioning
• Posture
• Pulmonary function
• Sitting
• Supine
• Standing

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