PULMONARY-FUNCTION AND POSTURE IN TRAUMATIC QUADRIPLEGIA

Objective: To determine optimum posture for pulmonary function in trau matic quadriplegia. Design: Lung function with changes in posture of n ormal healthy volunteers was compared with that of traumatic quadriple gic patients, Materials and Methods: Functional residual capacity (FRC ), Forced vital capacity (FVC), and arterial blood gases in room air w ere compared in 16 male patients aged 18 to 32 years, 8 of whom (group I) sustained traumatic quadriplegia (C6 to C7) at least 1 year previo usly, and 8 of whom (group II) were healthy volunteers. Measurements: FRC, FVC and blood gases were measured after 15 minutes in the followi ng random positions: 20 degrees head down, horizontal, 35 degrees head up, 60 degrees head up, and 90 degrees head up. Main Results: FRC was lower in all positions in group I but there was a similar directional change in FRC with posture in both groups. The greatest increase in F RC occurred in group I between the 35-degree head up and the 60-degree head up positions. Group I, in contrast to group II, decreased FVC fr om the 35-degree head up to the 60-degree head up position. There were no significant changes in Po, with position in group II, but quadripl egic patients showed Po, improvement from the head down to the horizon tal and 60-degree head up positions. Conclusions: In traumatic quadrip legia, maximum oxygenation and patency of alveoli (FRC) are achieved i n the 60- to 90-degree head up positions. In contrast to normal subjec ts, no changes in FRC and FVC occurred between the horizontal and 35 d egree head up positions in quadriplegia. The optimum position in these patients for physiotherapy (deep breathing and coughing, as reflected by maximum FVC) is the horizontal or 35-degree head up position. Thes e differences in lung volumes and oxygenation with posture may be impo rtant in optimizing respiratory care in traumatic quadriplegia.