Title: Good Lung UP or DOWN? Maneuvers to Improve Oxygenation in Acute Respiratory Failure
题目：健侧肺在上面还是在下面？在急性呼吸衰竭中提高氧合的方法
Author 作者: John Greenwood
翻译：葛赟 校正：肖锋
Patient Positioning During Mechanical Ventilation
机械通气时患者的体位
In any patient with acute respiratory failure, it is extremely important to consider patient positioning after initiating mechanical ventilation.  Both ventilation (V) and perfusion (Q) of the lungs can be significantly altered by manipulating the way you position your patient.  
对于急性呼吸衰竭的患者，在机械通气时体位非常重要。体位的改变可显著影响肺的通气和血流灌注。
•Routine Care: A good rule of thumb is to always keep the patient's head of bed > 30 degrees whenever possible to maximize diaphragmatic excursion, increase lung expansion, and prevent downstream incidence of ventilator associated pneumonias.
•常规护理：一种良好的经验性方法是尽可能保持患者床头高度≥30°，增加膈肌活动度，增加肺的扩张程度，预防呼吸机相关性肺炎的发生。
•Lateral Decubitus Positioning: Severe unilateral lung disease may warrant alternative patient positiong.
•侧卧位：严重的单侧肺部疾病可选择这种体位。
◦Good lung DOWN: In general, the good lung should be placed in the dependent position to improve V/Q matching.
•健侧肺在下面：一般情况下，健侧肺应在下方以提高V/Q比值。
◦Good lung UP:  Including massive hemoptysis (prevent blood from filling the good lung), large pulmonary abscesses (prevent pus from filling the good lung), & unilateral emphysema (prevent hyperinflation)
 
•健侧肺在上面：包括大量咳血（预防血沉积在健侧肺），大量肺脓肿（预防脓液沉积在健侧肺），单侧肺气肿（预防充气过度）。
Reverse Trendelenburg:  In the morbidly obese patient, or those who must remain flat in bed, a trick of the trade to achieve a pseudo-semirecumbent position is to utilize reverse trendelenburg to > 30 degrees.
反Trendelenburg法: 在极度肥胖患者，或那些强制平躺的患者，一个小技巧即是可用类半卧体位，即反转Trendelenburg位30°以上。