By physiotherapist Peter Maindal
Positioning in lying position is primarily used in order to create comfort for the client, as it reliefs pressure and prevents pain. Positioning is also used to optimize work, health and safety for the caregivers, when it comes to taking care of bedridden people. The question is whether there is enough focus on the fact that the lying position has a positive effect on and supports respiration.
Humans are strongly influenced by gravity, and in pulmonary physiotherapy we use the concepts declivial and nondeclivial. Declivial refers to the side that lies next to the sheet / mattress, while nondeclivial refers to the side that is turned away from the sheet / mattress.
These two concepts are very important for bedridden people with respiration problems.
A normal practice is for clients with respiration difficulties to lie down having the head of the bed elevated at ca. 30 degrees. When they sit or partially lie down, gravity will push the secretion from the lungs down to the bottom of the lung tissue. Therefore, clients cough less and can breathe easier. However, sitting or partially lying down affects the lungs’ functioning ability. This is particularly true for the lowest lung sections, where the secretion accumulates and fills the alveolar sacs. This can in time cause the lowest lung tissue to lose its elasticity.
If the clients lie in lateral position, the amount of secretion found in the nondeclivial side of the lung tissue will be more easily excreted. At the same time, the alveolar sacs in the lower section of the lung tissue on the nondeclivial side will move more. This way, the alveolar sacs maintain their elasticity.
It is important for the lung tissue to be ventilated and moved in this manner. Therefore, working with lateral positioning and turning from one side to the other is meaningful for the clients with respiration difficulties.
Lateral positioning may in some cases raise the concern that the client might fall in prone position, a position that challenges respiration. Therefore, it is important for the clients to experience lateral positioning as safe and stable, as insecurity can have a negative effect on respiration and can therefore worsen the clinical situation.
By using positioning products designed to provide stability, it will be possible to support and optimize the treatment of respiratory disorders. Practical experience suggests that lung diseases can be prevented by continuously and actively working with positioning. Clients have a lot to gain from this, as they encounter less respiration difficulties. At the same time, economy also wins, as this approach could ultimately save money on hospitalizations and expensive treatments.