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Body positional effect on gas exchange in unilateral pleural effusion
Sonnenblick M, Melzer E, Rosin AJ
Chest 1983 May;83(5):784-786
clinical trial
4/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

The positional effect on gas exchange was studied in eight patients who had unilateral pleural fluid without clinical or radiologic evidence of parenchymal lung disease. In all eight patients, PaO2 values were higher when the lung with the pleural fluid was uppermost. The mean PaO2 in this position was 71.9 +/- 9.3 mmHg (mean +/- SE) compared with 66.7 +/- 8.7 mmHg in the lateral decubitus position with the pleural fluid lowermost. The mean difference in PaO2 between the two positions was 5.1 +/- mmHg (p < 0.005). Larger positional differences were found in the patients with the smallest pleural effusions. These results are probably due to perfusion of areas of unventilated lung, accentuated by gravity with a consequent increase in shunting. A large effusion also causes a decrease in perfusion, so that ventilation-perfusion mismatching is decreased and the positional effect on gas exchange diminished.

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