Intensive Care Medicine: Published: 18 May 2026
Purpose
Comparing the effects of an out-of-bed armchair position
versus an in-bed semi-recumbent position on oxygenation in spontaneously
breathing intensive care unit (ICU) patients, receiving respiratory support is
a common practice with limited supported evidence.
Methods
A single-center randomized controlled trial in spontaneously
breathing adult ICU patients receiving invasive pressure support ventilation,
high-flow nasal oxygen, or non-invasive ventilation. Patients were assigned to
armchair or semi-recumbent in-bed positioning for 3 h. Arterial blood
gasses were obtained immediately before and after positioning. PaO2/FiO2 (P/F)
changes were analyzed with a linear mixed-effects model including group, time,
and their interaction, adjusted for stratification variables.
Results
284 patients were randomized (146 and 138 in the armchair
and bed groups, respectively). Baseline P/F ratios did not
differ between groups. A significant interaction between group and time was
observed (p = 0.002). In the armchair group,
the P/F ratio increased by
13 mm Hg (95% CI 1–24), whereas it decreased by 13 mm Hg (95% CI
− 25 to − 1) in the bed group. The post-positioning marginal
mean P/F ratio was higher in the armchair group (241 mm
Hg, 95% CI 214–268) than in the bed group (206 mm Hg, 95% CI
179–233; p = 0.004). No serious adverse
events occurred. Minor adverse events were more frequent in the armchair group
but had minimal impact on positioning duration.
Conclusion
In spontaneously breathing ICU patients receiving
respiratory support, out-of-bed armchair positioning was associated with higher
oxygenation after 3 h than remaining in a semi-recumbent position, with no
serious adverse events observed.
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