Purpose:

Pleural effusion is an abnormal accumulation of fluid in the intra-pleural space. It is not a disease entity unto itself. The relative annual incidence of pleural effusion is estimated to be 320 per 100,000 people in industrialized countries. Pleural fluid accumulation either displaces lung tissue or restricts the opening of adjacent alveolar sacs. It poses a unique threat to oxygen transport as a result of its direct physical effect on the lung, heart or both.

Relevance: 

In pleural effusion positioning may be used to optimize gas-exchange. Studies have shown that position will have effect on intra pleural pressure and on ventilation. The therapeutic body positioning is a primary non-invasive physical-therapy intervention. This study is designed to investigate the effects of different body positioning on pulmonary function tests in unilateral pleural effusion patients.

Participants:

Randomly selected 25 Subjects(21 analysed as 4 dropped out), irrespective of sex, of the age group 20–50 years with unilateral pleural effusion, who are able to comprehend commands and willing to participate were included in study. Patients with Bilateral pleural effusion, Hemodynamically unstable and any orthopaedic conditions preventing them from assuming the required positions were excluded.

Method:

The presence of pleural effusion was assessed by physical examination (chest expansion, auscultation etc) and chest x- ray (level of fluid-size of effusion). Subjects were instructed to refrain from vigorous exercise and eating a heavy meal within 2 hours of the test and to wear comfortable, non-restrictive clothing. Pulmonary function testing (RMS HELIOS Spirometer) was conducted in sitting, right and left lateral decubitus positions. A forced expiratory maneuver was performed three times in each position after maintaining that position for 20 minutes and with rest as needed by the patient, between trials. It was made sure that subjects understood the instructions and performed the test with standard guideline (ATS Guidelines). The best values of forced vital capacity (FVC) and forced expiratory volume (FEV) were analysed. The outcome measures: FVC, forced expiratory volume in 1 second (FEV1) and FEV1/FVC

Analysis:

The outcome was cross matched with the expected FVC values and with each three positional FVC value.Parameters was expressed as mean values ± standard deviation. Analysis of variance was used to determine the effect of body position on Spirometric parameters.

Result:

No significant difference (p > 0.10) was noted in FVC, FEV1 and FEV1/FVC values between the three positions. Although, mean values of FVC in sitting position (41.6 ± 12.20) was higher than mean value of FVC of lateral positions. In lateral decubitus position the mean FVC value of effusion lung upper most (37.8 ± 11.50) was slightly higher than effusion lung dependant (36.5 ± 12.8).

Conclusion:

Position does not appear to have a significat effect on PFT in unilateral effusion patients. Further study required with more sample size including the other cardiorespiratory parameters (ABG, SpO₂ etc) and by subjective measurements.

Implications:

Any three positions can use interchangeably during rest and during physiotherapy treatment.

Keywords:

Pleural effusion, FVC, FEV1

Funding Source Acknowledgement 

S.B.B College of Physiotherapy, Ahmedabad.