Effects of prone position on alveolar recruitment and oxygenation in acute lung injury

Guérin, Claude; Badet, Michel; Rosselli, Sylvaine; Heyer, Laurent; Sab, J. M.; Langevin, Brigitte; Philit, F.; Fournier, G.; Robert, Dominique

doi:10.1007/s001340051050

Cited by 118 publications

(56 citation statements)

References 25 publications

(30 reference statements)

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“…Prone positioning, reported for the first time in 1976 by Piehl et al [79] has a special place in lung recruitment. Most studies found an improvement in oxygenation, although a substantial number of patients do not respond and the beneficial effect usually disappears after reversal to the supine position [60,70,71,[80][81][82][83][83][84][85][86]. The increase in oxygenation in the prone position is explained by recruitment-related mechanisms such as improved ventilation through decreased alveolar compression by the heart and recruitment-independent mechanisms, e.g.…”

Section: Human Studiesmentioning

confidence: 99%

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Halbertsma¹,

Hoeven

2005

Anaesthesia

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Summary A literature review was conducted to assess the evidence for recruitment manoeuvres used in conventional mechanical positive pressure ventilation. A total of 61 studies on recruitment manoeuvres were identified: 13 experimental, 31 ICU, 6 PICU and 12 anaesthesia studies. Recruitment appears to be a continuous process during inspiration and expiration and is determined by peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP). Single or repeated recruitment manoeuvres may result in a statistically significant increase in oxygenation; however, this is short lasting and clinically irrelevant, especially in late ARDS and pneumonia. Temporary PIP elevation may be effective but only after PEEP loss (for example disconnection and tracheal suctioning). Continuous PEEP elevation and prone positioning can increase Pao2 significantly. Adverse haemodynamic or barotrauma effects are reported in various studies. No data exist on the effect of recruitment manoeuvres on mortality, morbidity, length of stay or duration of mechanical ventilation. Although recruitment manoeuvres can improve oxygenation, they can potentially increase lung injury, which eventually determines outcome. Based on the presently available literature, prone position and sufficient PEEP as part of a lung protective ventilation strategy seem to be the safest and most effective recruitment manoeuvres. As paediatric physiology is essentially different from adult, paediatric studies are needed to determine the role of recruitment manoeuvres in the PICU.

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Section: Human Studiesmentioning

confidence: 99%

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Halbertsma¹,

Hoeven

2005

Anaesthesia

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“…26) The following mechanisms underlying the respiratory effects observed in the prone position have been suggested: improved redistribution of ventilation in the dorsal lung areas, an increased tidal volume in relation to modulated chest wall movement, 27) alveolar recruitment, 28) alterations in compressive forces exerted by the heart on the lungs 29) and improved clearance of secretions. 30) In contrast to that observed in the lateral decubitus position, in the prone position, the mediastinal structures lie naturally and the chest and abdomen are free of compression.…”

Section: Respiratory and Circulatory Physiology In The Prone Positionmentioning

confidence: 99%

“…35) Using the PP to improve the operative view, some surgeons have been able to operate without the use of onelung ventilation via a double-lumen endotracheal tube. 28) The absence of one-lung ventilation reduces arteriovenous shunting with superior preserved oxygenation. 24,36) Therefore, the use of two-lung ventilation, or at least partial lung deflation, in the PP may reduce the incidence of collapsed lung and the need for reinflation of the lungs which are well known to produce inflammatory mediators, 37) possibly resulting in a reduction in the frequency of pulmonary-related complications, although this hypothesis remains unproven clinically.…”

Section: Respiratory and Circulatory Physiology In The Prone Positionmentioning

confidence: 99%

Thoracoscopic Esophagectomy Using Prone Positioning

Noshirο

Miyake

2013

ATCS

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Thoracotomic esophagectomy followed by cervical and abdominal procedures has been conventionally performed as the best curable operative procedure for treating invasive thoracic esophageal carcinoma. Despite improvements in the survival rate, the procedure is associated with significant operative morbidity and mortality rates due to the extreme invasiveness of an extensive dissection of the lymph nodes. Minimally invasive esophagectomy (MIE) was developed to reduce surgical invasiveness. Recently, the use of thoracoscopic esophagectomy performed in the prone position has stimulated new interest in minimally invasive approaches. However, the advantages and disadvantages of this technique are not well known. In this review, the literature to date, including series and comparative studies of minimally invasive esophagectomy performed in the prone position, is summarized, and the various lessons learned and controversies surrounding this technique are addressed.

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“…The contraindications are hemodynamic compromise, high intracranial pressure (15), pregnancy, lung emphysema, bronchopleural fistula, pneumothorace and right heart failure. Several methods have been described to perform recruitment maneuver: sights (16), sustained inflation (17), staircase method (14), and prone positioning (18). The volume of lung recruited during a recruitment maneuver is a combination of pressure and time.…”

Section: Recruiting the Lungmentioning

confidence: 99%

Lung recruitment in ARDS patients

Arnal¹,

Garnero²

2012

AML

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Lung recruitment is used to improve oxygenation and decrease the risk of ventilator induced lung injuries. Assessing the potential of recruitability is a pre-requisite for a rational recruitment strategy and setting of PEEP. Using a low flow pressure-volume loop is helpful to assess the potential of recruitability at the bedside. For patients with a high potential of recruitability, recruitment maneuvers are efficient with an appropriate setting of PEEP to maintain the lung recruited. Recruitment maneuvers use pressures from 40 to 60 cmH 2 O for a short period of time, either with the sustained inflation or the staircase method. PEEP setting after the maneuver is important; a decreasing PEEP trial is a useful practical method.

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Effects of prone position on alveolar recruitment and oxygenation in acute lung injury

Abstract: Alveolar recruitment may be a mechanism of oxygenation improvement in some patients with acute hypoxemic respiratory failure. No correlation was found between change in oxygenation and chest wall elastic properties.

Cited by 118 publications

References 25 publications

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Lung recruitment during mechanical positive pressure ventilation in the PICU: what can be learned from the literature?

Thoracoscopic Esophagectomy Using Prone Positioning

Lung recruitment in ARDS patients

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