Effects of prone position on the oxygenation of patients with acute respiratory distress syndrome

Abstract

CONTEXT AND OBJECTIVE: Acute respiratory distress syndrome (ARDS) is characterized by arterial hypoxemia, and prone position (PP) is one possible management strategy. The objective here was to evaluate the effects of PP on oxygenation. DESIGN AND SETTING: Non-randomized, open, prospective, controlled clinical trial, in a surgical intensive care unit at a tertiary university hospital. METHODS: Forty-one ARDS patients underwent PP for three-hour periods. Arterial partial oxygen pressure (PaO2) was measured immediately before changing to PP, after 30, 60, 120 and 180 minutes in PP and 60 minutes after returning to dorsal recumbent position (DP). The paired-t and Dunnett tests were used. RESULTS: A notable clinical improvement in oxygenation (> 15%) was detected in 78.0% of patients. This persisted for 60 minutes after returning to DP in 56% and lasted for 12 and 48 hours in 53.6% and 46.3%, respectively. Maximum improvement was seen after 30 minutes in 12.5% of responding patients and after 180 minutes in 40.6%. No statistically significant associations between PP response and age, gender, weight, PEEP level, tidal volume, respiratory rate, PaO2/FiO2 or duration of mechanical ventilation were detected. One accidental extubation and four cases of deterioration through oxygenation were detected. The 48-hour mortality rate was 17%. CONCLUSIONS: For a significant number of ARDS patients, PP may rapidly enhance arterial oxygenation and its inclusion for management of severe ARDS is justified. However, it is not a cost-free maneuver and caution is needed in deciding on using PP.

Prone Position during ECMO is Safe and Improves Oxygenation

“…Only a few studies evaluated the persistent improvement in oxygenation after PrP, i.e. in the supine position as we did (22, 30, 31). The increase in oxygenation in our study was comparable to results of a meta-analysis in patients without ECMO (32).…”

Using the prone position for ventilated patients with respiratory failure: a review

“…However, only Johannigman et al (2000) reported the use of a specialist proning device (Vollman Prone Positioner; Hill‐ROM, Batesville, IN, USA), and none of the studies documented the use of cushions. Hering et al (2001) and Rossetti et al (2006) did report that no cushions or measures were taken to alleviate positional restrictions of the abdomen. This means that ICU nurses do not have clear guidance as to how best to achieve a ‘free abdomen’ in patients who they position prone.…”

“…A non‐randomized trial by Rossetti et al (2006) demonstrated a significant correlation between patients' body weight and response to the prone position, with a trend towards those who were heavier responding better. This finding would support the understanding that in the supine position the organs of the abdominal cavity restrict the movement of the diaphragm, thereby reducing residual capacity and closure of the alveoli in dependent zones (Marik, 2001).…”

Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo

“…Rossetti et al (33) investigated the effect of three hours ventilation in prone position on arterial oxygenation in ARDS patients. Forty one patients with diagnosis criteria for ARDS where included in this trial.…”