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. In India & Africa, in majority of young adult’s pleural effusion developing as an acute disorder most commonly due to tuberculosis. It poses a unique threat to oxygen transport as a result of its direct effect on the lung, heart or both.

Relevance

In pleural effusion, physiotherapy is limited. Positioning can be used to optimize gas- exchange. Understanding the physiological effects of body position on oxygen transport and how physiotherapy disrupts these normal processes is fundamental to prescribing body positioning. Oxygen transport can be improved, maintained or worsened with changes in body position. This study is designed to investigate the effects of different body positioning on pulmonary function tests in unilateral pleural effusion patients.

Participants/Subjects:

The present study included randomly selected 21(16 Male/ 5 Female) patients with unilateral pleural effusion between the ages of 20-50 years with mean age of 33.3+10.7 years, mean body weight 46kg and mean height 164cm on the basis of exclusion/inclusion criteria.

Method:

Patients with unilateral pleural effusion were screened after finding their suitability as per inclusion and exclusion criteria. The presence of pleural effusion was assessed by physical examination and chest x- ray. All subjects were refrained from vigorous exercise & to avoid eating a heavy meal within 2 hours of the test and to wear comfortable, non-restrictive clothing. Spirometry was conducted (pulmonary function testing) on the subjects in three positions which include: sitting, right lateral and left lateral decubitus positions. A forced expiratory manoeuvre was performed three times in each position with rest as needed by the patient, between trials. Forced expiratory manoeuvre was performed 20 minutes after assumption of a new position by the patients. It was made sure that subjects understood the instructions and performed the test with standard guideline (ATS Guidelines). The best values of FVC- FEV were selected for analysis. The patients were connected to the mouthpiece with nose-clip on place for Spirometry. The following parameters were included in the study: FVC, FEV1, and FEV1/FVC

Analysis:

Data was tested for normality by using the method Kolmogorov and Smirniv.The result were analysed by ANOVA (parametric).

Result:

No significant difference (p > 0.10) in FVC values of all three positions. Although, mean values of FVC in sitting position (41.6 ± 12.20) is higher than mean value of FVC of lateral positions. In lateral decubitus position the mean FVC value of effusion lung up (37.8 ± 11.50) is slightly higher than effusion lung down (36.5 ± 12.8). 

Conclusion:

Position does not have effect on PFT in unilateral effusion patients. Further study required with more sample size including the other respiratory and cardiovascular parameters and by subjective measurements. 

 Implications:

Any three positions can use interchangeably. 

 Keywords

Pleural effusion, FVC, FEV1