Application of the 45° Semi-Fowler Position and Pursed Lip Breathing in STEMI Patients with Ineffective Breathing Pattern

A Case Study

Authors

  • Muhammad Fahrul Farizqi Universitas Muhammadiyah Malang, Indonesia
  • Indah Dwi Pratiwi Universitas Muhammadiyah Malang, Indonesia

DOI:

https://doi.org/10.56127/jukeke.v5i2.2897

Keywords:

ineffective breathing pattern, Pursed Lip Breathing, respiratory status, Semi-Fowler position, ST-Elevation Myocardial Infarction

Abstract

ST-Elevation Myocardial Infarction (STEMI) is a cardiovascular emergency caused by complete occlusion of a coronary artery, which may result in myocardial ischemia, decreased cardiac function, pulmonary congestion, and impaired tissue oxygenation. Respiratory problems such as dyspnea, increased respiratory rate, and ineffective breathing pattern may occur in STEMI patients and require supportive nursing interventions. The combination of the 45° Semi-Fowler position and Pursed Lip Breathing is a simple non-pharmacological intervention that may help improve ventilation and oxygenation. Objective: This study aimed to describe the implementation of the combination of the 45° Semi-Fowler position and Pursed Lip Breathing in improving respiratory status among STEMI patients with ineffective breathing pattern. Methodology: This study used a descriptive nursing case study design involving two STEMI patients treated in the Intensive Cardiac Care Unit. Data were collected through direct observation of respiratory status before and after the intervention. The observed indicators were peripheral oxygen saturation (SpO₂) and respiratory rate. The data were analyzed descriptively by comparing respiratory parameters during the three-day observation period. Findings: The results showed a tendency toward improvement in respiratory status in both patients. Oxygen saturation increased from 96% to 98%, while respiratory rate decreased from 20–24 breaths per minute before the intervention to 16–20 breaths per minute after the intervention. Implications: The findings suggest that the combination of the 45° Semi-Fowler position and Pursed Lip Breathing may be used as a supportive independent nursing intervention to help improve oxygenation and reduce breathing effort in STEMI patients, without replacing standard medical therapy. Originality: This study provides a clinical description of the combined use of body positioning and breathing exercise in STEMI patients with ineffective breathing pattern, an area that remains limited in previous nursing case studies.

References

Amalia, Y. D. (2025). Penerapan posisi Semi-Fowler dan Pursed Lip Breathing pada pasien STEMI di IGD PKU Muhammadiyah Yogyakarta. Jurnal Kesehatan Medika Saintika, 16(1), 151-157.

Hofmann, R., James, S. K., Jernberg, T., Lindahl, B., Erlinge, D., Witt, N., Arefalk, G., Frick, M., Alfredsson, J., & Nilsson, L. (2017). Oxygen therapy in suspected acute myocardial infarction. The New England Journal of Medicine, 377(13), 1240-1249. https://doi.org/10.1056/NEJMoa1706222

Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L. P., Crea, F., Goudevenos, J. A., & Halvorsen, S. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 39(2), 119-177. https://doi.org/10.1093/eurheartj/ehx393

Kementerian Kesehatan, R. I. (2018). Laporan Nasional Riskesdas 2018.

Mayer, A. F., Karloh, M., Dos Santos, K., de Araujo, C. L. P., & Gulart, A. A. (2018). Effects of acute use of pursed-lips breathing during exercise in patients with COPD: A systematic review and meta-analysis. Physiotherapy, 104(1), 9-17. https://doi.org/10.1016/j.physio.2017.08.007

Mocan, D. (2025). Unveiling the systemic impact of congestion in heart failure: A narrative review of multisystem pathophysiology and clinical implications. Journal of Cardiovascular Development and Disease, 12(4). https://doi.org/10.3390/jcdd12040124

Pereira de Araujo, C. L., Karloh, M., Martins dos Reis, C., Palu, M., & Fleig Mayer, A. (2015). Pursed-lips breathing reduces dynamic hyperinflation induced by activities of daily living test in patients with chronic obstructive pulmonary disease: A randomized cross-over study. Journal of Rehabilitation Medicine, 47(10), 957-962. https://doi.org/10.2340/16501977-2008

Ppni. (2017). Standar Diagnosis Keperawatan Indonesia: Definisi dan Indikator Diagnostik (1 ed.). Dewan Pengurus Pusat Persatuan Perawat Nasional Indonesia.

Ppni. (2018). Standar Intervensi Keperawatan Indonesia: Definisi dan Tindakan Keperawatan (1 ed.). Dewan Pengurus Pusat Persatuan Perawat Nasional Indonesia.

Ppni. (2019). Standar Luaran Keperawatan Indonesia: Definisi dan Kriteria Hasil Keperawatan (1 ed.). Dewan Pengurus Pusat Persatuan Perawat Nasional Indonesia.

Purnamasari, A. T. (2024). Combination of high flow nasal cannula and Semi-Fowler position to increase oxygenation with acute lungs. 8(2), 261-267.

Rahmadhanty, A. (2022). Pursed-lip breathing technique in increasing oxygen saturation and decreasing dyspnea in patients with chronic obstructive pulmonary disease: Literature review. Media Keperawatan Indonesia, 5(3), 247-254.

Rahmah, G. N., Kahtan, M. I., Fauzan, S., & Lili Neri, E. (2024). The effect of Semi-Fowler position on oxygen saturation in patients with chronic heart failure in West Kalimantan. Dunia Keperawatan: Jurnal Keperawatan dan Kesehatan, 12(1), 31-37. https://doi.org/10.20527/jdk.v12i1.615

Roberts, S. E., Schreuder, F. M., Watson, T., & Stern, M. (2017). Do COPD patients taught pursed lips breathing for dyspnoea management continue to use the technique long-term? A mixed methodological study. Physiotherapy, 103(4), 465-470. https://doi.org/10.1016/j.physio.2016.05.006

Sakhaei, S., Ebrahimpour Sadagheyani, H., Zinalpoor, S., Khorami Markani, A., & Motaarefi, H. (2018). The impact of pursed-lips breathing maneuver on cardiac, respiratory, and oxygenation parameters in COPD patients. Open Access Macedonian Journal of Medical Sciences, 6(10), 1851-1856. https://doi.org/10.3889/oamjms.2018.407

Sari, N. N. N., Rahmasari, I., Widiastuti, A., Utomo, E. K., & Yudhianto, K. A. (2025). Efektivitas posisi Semi-Fowler 45° pada kualitas tidur pasien congestive heart failure. Triage: Jurnal Ilmu Keperawatan, 12(2), 108-113. https://doi.org/10.61902/triage.v12i2.1943

Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., & White, H. D. (2019). Fourth universal definition of myocardial infarction (2018). European Heart Journal, 40(3), 237-269. https://doi.org/10.1093/eurheartj/ehy462

Vatwani, A. (2019). Pursed lip breathing exercise to reduce shortness of breath. Archives of Physical Medicine and Rehabilitation, 100(1), 189-190. https://doi.org/10.1016/j.apmr.2018.05.005

Who. (2021). World Health Statistics 2021: Monitoring Health for the SDGs, Sustainable Development Goals.

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Published

2026-07-01

How to Cite

Farizqi, M. F., & Pratiwi, I. D. (2026). Application of the 45° Semi-Fowler Position and Pursed Lip Breathing in STEMI Patients with Ineffective Breathing Pattern: A Case Study. Jurnal Kesehatan Dan Kedokteran, 5(2), 767–779. https://doi.org/10.56127/jukeke.v5i2.2897

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