Effects of the prone position on gas exchange and hemodynamics in severe acute respiratory distress syndrome

Abstract

Based on the data from this study, the prone position can improve oxygenation in severely hypoxemic ARDS patients without deleterious effects on hemodynamics. This beneficial effect does not immediately disappear on return to the supine position. In our patients, an absence of response to this technique was not accompanied by worsening hypoxemia or hemodynamic instability. Repeated daily trials in the prone position should be considered in the management of ARDS patients with severe hypoxemia.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…Meta-analysis including this study demonstrated reduced mortality in patients treated with prone compared with supine position (RR 0.85; 95% CI 0.71-1.01) as well as improved oxygenation as measured by change in Pao 2 /Fio 2 ratio (median 24.03 higher, 95% CI 13.3-34.7 higher) [375]. Most patients respond to the prone position with improved oxygenation and may also have improved lung compliance [374,[376][377][378][379]. While prone position may be associated with potentially life-threatening complications including accidental removal of the endotracheal tube, this was not evident in pooled analysis (RR 1.09; 95% CI 0.85-1.39).…”

Pediatric acute lung injury

“…Promising clinical observations in adult ALI/ARDS patients demonstrated that prone position improves oxygenation by 70 -80% [103][104][105][106]. A trend towards lower mortality was observed when patients suffered from severe ARDS and when they were put in prone position within 48 hours after onset of ALI/ARDS for at least 17 hours per day lasting 7 days.…”

Ajustes da pressão positiva expiratória final ideal na síndrome do desconforto respiratório agudo na posição prona

“…Com relação aos parâmetros ventilatórios utilizados nos três momentos da pesquisa (Pinsp, f, FiO 2 , Vt, e Ve), não foram observadas modificações significativas em nenhuma das fases propostas. Porém, ao relacioná-los isoladamente notou-se que: quanto maior o valor da PEEP e menor volume-corrente, complacência estáti-ca, pH, PaO 2 , e SaO 2 maior a mortalidade 15,22,34,[35][36][37][38][39][40][41][42][43][44] . Optou-se em realizar o protocolo iniciando na posição supina, pela facilidade de todos os pacientes estarem nesta posição, no entanto se tivessem sido aleatorizados e alguns iniciassem o estudo na posição prona, talvez os resultados pudessem ser diferentes do exposto pela diminuição do efeito carry-over ou de evolução temporal da doença.…”