Effects of Prone Positioning on Lung Protection in Patients with Acute Respiratory Distress Syndrome

Cornejo, Rodrigo; Diaz, Juan Carlos J Sotillo; Tobar, Eduardo; Bruhn, Alejandro; Ramos, Cristóbal; González, Roberto; Repetto, Claudia A.; Romero, Carlos; Gálvez, Luis Ricardo; Llanos, Osvaldo; Arellano, D.; Neira, Wilson R.; Díaz, Gonzalo Antonio Neme; Zamorano, Anibal; Pereira, Gonzalo L.

doi:10.1164/rccm.201207-1279oc

Cited by 192 publications

(168 citation statements)

References 45 publications

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“…The improvement of the ventilation/perfusion ratio is determined by positioning the ventilated alveoli in the dependent regions, where perfusion gravitationally predominates, and by decreasing the overdistension of ventral areas, with a reduction of alveolar wall injury. Indeed, prone positioning was demonstrated to enhance lung recruitment and to decrease alveolar instability at the same time [25,26]. A significant improvement of PaO 2 /FIO 2 has been shown by ventilating patients in the prone position [27].…”

Section: Computed Tomographymentioning

confidence: 98%

Overview of current lung imaging in acute respiratory distress syndrome

2014

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Imaging plays a key role in the diagnosis and follow-up of acute respiratory distress syndrome (ARDS). Chest radiography, bedside lung ultrasonography and computed tomography scans can provide useful information for the management of patients and detection of prognostic factors. However, imaging findings are not specific and several possible differential diagnoses should be taken into account. Herein we will review the role of radiological techniques in ARDS, highlight the plain radiological and computed tomography findings according to the pathological stage of the disease (exudative, inflammatory and fibroproliferative), and summarise the main points for the differential diagnosis with cardiogenic oedema, which is still challenging in the acute stage. @ERSpublications ARDS diagnosis is still based on radiological criteria; the variety of these findings should be known and recognised

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Section: Computed Tomographymentioning

confidence: 98%

Overview of current lung imaging in acute respiratory distress syndrome

2014

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“…Prone positioning Prone positioning Prone positioning Prone positioning Prone positioning The prone position is a relatively simple and safe method for improved oxygenation, which can be regarded as a recruitment maneuver itself, improving gas exchange, promoting alveolar recruitment, without providing areas of hyperinflation 2,9 . When patients are placed in the prone position, the chest wall compliance decreases, and the P TP is redistributed from dorsal to ventral and, as a consequence, there is a recruitment of pulmonary dorsal regions, which directly reflects the improvement in patient's oxygenation [10][11][12] .…”

Section: Methods Methods Methods Methodsmentioning

confidence: 99%

Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

Santos

Samary

Júnior

et al. 2015

Rev. Col. Bras. Cir.

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Supporting patients with acute respiratory distress syndrome (ARDS), using a protective mechanical ventilation strategy characterized by low tidal volume and limitation of positive end-expiratory pressure (PEEP) is a standard practice in the intensive care unit. However, these strategies can promote lung de-recruitment, leading to the cyclic closing and reopening of collapsed alveoli and small airways. Recruitment maneuvers (RM) can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and the optimal method and patient selection for recruitment maneuvers have not been determined, considerable uncertainty remaining regarding the appropriateness of RM. This review aims to discuss recent findings about the available types of RM, and compare the effectiveness, indications and adverse effects among them, as well as their impact on morbidity and mortality in ARDS patients. Recent developments include experimental and clinical evidence that a stepwise extended recruitment maneuver may cause an improvement in aerated lung volume and decrease the biological impact seen with the traditionally used sustained inflation, with less adverse effects. Prone positioning can reduce mortality in severe ARDS patients and may be an useful adjunct to recruitment maneuvers and advanced ventilatory strategies, such noisy ventilation and BIVENT, which have been useful in providing lung recruitment.

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“…Direct proof of VILI is nearly impossible to obtain in "real" ARDS patients, but a recent PET study [16] showed that the nonhomogeneous lung regions at the interface between collapsed and inflated lung tissue, where putatively intra-tidal collapse and decollapse occur, are always inflamed. Despite the relevance of the issue of opening and closing, just two studies measured intra-tidal collapse and decollapse at two different PEEP levels keeping the tidal volume constant and both were unable to demonstrate a significant intra-tidal collapse and decollapse reduction [11,18]. We measured intra-tidal collapse and decollapse in 34 ARDS patients (18 severe ARDS) keeping the tidal volume constant at two PEEP levels, 5 and 15, which are close to the PEEP levels applied in all clinical trials.…”

Section: Is Opening and Closing Real And What Is The "Real" Effect Ofmentioning

confidence: 99%

Does high PEEP prevent alveolar cycling?

Cressoni

Chiurazzi

Chiumello

et al. 2017

Med Klin Intensivmed Notfmed

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Effects of Prone Positioning on Lung Protection in Patients with Acute Respiratory Distress Syndrome

Abstract: Prone positioning enhances lung recruitment and decreases alveolar instability and hyperinflation observed at high PEEP in patients with ARDS.

Cited by 192 publications

References 45 publications

Overview of current lung imaging in acute respiratory distress syndrome

Overview of current lung imaging in acute respiratory distress syndrome

Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

Does high PEEP prevent alveolar cycling?

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