Iran J Radiol. 2015 April; 13(2):e20919. doi: 10.5812/iranjradiol.20919.

Published online 2015 March 12. Research Article

EFFECT OF LATERAL POSITION ON GAS EXCHANGE IN

PATIENTS WITH UNILATERAL PLEURAL EFFUSION

S. ROMERO*, C. MARTfN, L. HERNANDEZ, J. M. ARRIERO, N. BENITO AND J. GIL

Hospital General Universitario S. V.S. de Alicante, Alicante, Spain

Received 2013 June 03, Revised 2013 August 02;Accepted 2013 September 21.

The objective of this study was to evaluate the effect of lateral body position on gas
exchange in patients with unilateral pleural effusion, with special reference to the influence
of effusion volume.
Thirty consecutive patients with unilateral pleural effusion, without evidence of
parenchymal pulmonary involvement, were entered into the study.
Arterial blood gas tensions (PaO,, PaCO,) were randomly measured in both right and
left lateral decubitus body positions, while breathing room air. To assess the influence of
the effusion volume, roentgenographic and functional parameters were used. Among the
latter, FVC, FEV,, TLC and RV were determined. The influence of the presence or
absence of pleuritic pain on gas exchange was also assessed.
There was no significant difference in PaCO, between right and left lateral decubitus
body positions (3 1.1 f 4.2 vs. 31.0 f 4.5 mmHg). The differences in PaO, between the
two body positions ranged from 0.5-25 mmHg (mean 9.3 f 6.6 mmHg). Mean PaO, with
the normal-side (control) down (Pa02-N) (81.4 f 8.5 mmHg) was higher, but without
significant statistical difference, than mean PaO, with the effusion-side down (PaO,-E)
(78.0 f 12.5 mmHg). PaO,-N was higher than PaO,-E in 22 of 30 patients (conventional),
and lower in eight patients (paradoxical). No consistent relationship was found for
alterations in PaO, in different positions with the volume of effusion, either when
estimated by a roentgenographic method or when using spirometric or plethysmographic
values. The mean difference between PaO, values in the two positions (dPaO* N-E) (6.3 f
9% mmHg) in patients with chest pain was significantly greater (PcO.05) than the dPa0,
N-E in patients without pain ( - 3.3 % 10.7 mmHg). Moreover, only pleuritic chest pain
showed a significant statistical influence on dPa0, N-E, when all factors were analysed
simultaneously.
Although gas exchange is improved in most patients in the lateral decubitus position
with normal-side down, some patients behave paradoxically. This difference does not
appear to be related to the effusion volume, but seems to be influenced by the presence
of pleural pain.
Introduction decubitus position, with the effusion- side
down. They concluded that the volume of
Gravity can be used to improve gas the effusion was the main determinant of
exchange in patients with unilateral lung gas exchange behaviour, and that this
disease, if such patients are positioned so paradoxical change will take place when
that the good lung is gravity dependent (l- the pleural effusion is large enough.
3). Reversal of this gravitational advantage Although they failed to find a consistent
has seldom been observed in adult patients relation- ship between effusion volume
(4,5), although it may be the rule in estimated by chest roentgenograms and
infants (6). In patients with unilateral alterations in PaO, during different
pleural effusions, the PaO, decreases most positions, they did find a high correlation
when they are positioned such that the between these alterations and volumes
less-ventilated lung, compressed by pleural estimated by spirometry.
fluid, is in the dependent position (7,8). The main purpose of the present study
Recently however, Chang et al. (9) found was to evaluate the effect of effusion
that eight of 21 patients with unilateral volume on the behav-iour of gas exchange
pleural effusions had higher values of PaO, in different decubitus positions.
when they were positioned in the lateral