Effects of Out-of-Bed Armchair Positioning on Oxygenation in Spontaneously Breathing ICU Patients Receiving Respiratory Support: A Randomized Controlled Trial
Abstract
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. 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. 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. 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. NCT04446559.
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BibTeX
@article{fossat2026effects,
title = {{Effects of Out-of-Bed Armchair Positioning on Oxygenation in Spontaneously Breathing ICU Patients Receiving Respiratory Support: A Randomized Controlled Trial}},
author = {Guillaume Fossat and Lucie Muller and Aline Seguin and Armelle Mathonnet and Séverine Pinos and Toufik Kamel and François Barbier and Céline Loiseau and Marion Guemann and Léa Courtes and Cécile Fossat and Grégoire Muller and Mai-Anh Nay and Thierry Boulain},
journal = {Intensive Care Medicine},
year = {2026},
month = oct,
doi = {10.1007/s00134-026-08453-y},
url = {https://normandie-univ.hal.science/hal-05835551v1},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Effects of Out-of-Bed Armchair Positioning on Oxygenation in Spontaneously Breathing ICU Patients Receiving Respiratory Support: A Randomized Controlled Trial
AU - Guillaume Fossat
AU - Lucie Muller
AU - Aline Seguin
AU - Armelle Mathonnet
AU - Séverine Pinos
AU - Toufik Kamel
AU - François Barbier
AU - Céline Loiseau
AU - Marion Guemann
AU - Léa Courtes
AU - Cécile Fossat
AU - Grégoire Muller
AU - Mai-Anh Nay
AU - Thierry Boulain
PY - 2026
DA - 2026/10/22
JO - Intensive Care Medicine
DO - 10.1007/s00134-026-08453-y
UR - https://normandie-univ.hal.science/hal-05835551v1
AB - 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. 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. 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. 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. NCT04446559.
SN - 0342-4642
SN - 1432-1238
ER -