ArticleJournal of thoracic disease2026
Hemodynamic and ventilatory effects of stepwise head-of-bed elevation in acute respiratory distress syndrome patients undergoing high-flow nasal cannula: a prospective sequential physiological study.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: High-flow nasal cannula (HFNC) therapy is widely utilized in patients with acute respiratory distress syndrome (ARDS) due to its significant clinical efficacy. While guidelines exist for positioning during invasive ventilation, the optimal head-of-bed (HOB) elevation for ARDS patients receiving HFNC is unknown, balancing recruitment benefits against risks like hemodynamic compromise. Therefore, this study aimed to evaluate the short-term effects of stepwise HOB elevation (15°, 30°, 45°, and 60°) on oxygenation, ventilation distribution, and hemodynamics in ARDS patients receiving HFNC therapy. Methods: This prospective, single-center, sequential physiological study enrolled 20 adult ARDS patients [Berlin definition; arterial oxygen partial pressure (PaO Results: The mean P/F ratios (mmHg) at each angle were: 15°: 160.00±59.66, 30°: 162.42±53.36, 45°: 176.66±70.92, 60°: 184.24±68.63. Significant pairwise differences (P<0.05, adjusted) were observed for 15° Conclusions: In this sequential study, stepwise HOB elevation to 45° and 60° was associated with significantly higher P/F ratios and a favorable redistribution of ventilation toward dependent lung regions compared to lower angles, without apparent hemodynamic compromise in the short term. These physiological findings suggest potential benefit but require validation in randomized studies to account for temporal and order effects.
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