Effects of ventilation in ventral decubitus position on respiratory mechanics in adult respiratory distress syndrome

Servillo, Giuseppe; Roupie, É.; Robertis, Edoardo De; Rossano, F; Brochard, Laurent; Lemaire, François; Tufano, R

doi:10.1007/s001340050489

Cited by 68 publications

(56 citation statements)

References 36 publications

(41 reference statements)

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“…Assuming that overall compliance of the diaphragmatic wall remains unchanged in the prone position, since the intra-abdominal pressure did not change, it could be supposed that the decrease in thoracoabdominal compliance arises through a greater stiffness of the posterior, compared to the anterior, wall of the thorax when free to move. Other authors have shown an improvement in respiratory system compliance in the prone position, but their data mainly refer to patients with "secondary" ARDS (nonpulmonary insult) [23][24][25]. Interestingly, respiratory system compliance is improved when patients are returned to the supine position [22].…”

Section: Effects On Respiratory Mechanicsmentioning

confidence: 99%

“…Only a minority (7%) investigated the effects between 2-4 h [27,61,62]. The majority of the studies investigated patients with a predominance (w80% of the studies) of primary ARDS [22, 27, 39-41, 43, 57] while a minority investigated patients with a predominance of secondary ARDS (11%) [24,56,62,63]. Approximately 40% investigated a group of patients with equally distributed primary and secondary ARDS (between 20-80%) [4,5,18,23,26,28,42,50,60,61].…”

Section: An Overview Of the Literaturementioning

confidence: 99%

“…The majority of the studies (63%) did not describe the support used for pronation [26,27,39,40,42,43,[51][52][53][54][55][57][58][59][60][61]. Thus, 20% did not release the abdomen [23,56], whilst 80% attempted to ensure free abdominal movements [4,5,18,22,24,25,28,41,50,62,63]. All but three of the studies investigated the effects of prone position in the acute phase [28,59,61].…”

Section: An Overview Of the Literaturementioning

confidence: 99%

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Prone position in acute respiratory distress syndrome

Pelosi¹,

Brazzi²,

Gattinoni³

2002

European Respiratory Journal

271

167

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In the last few years prone positioning has been used increasingly in the treatment of patients with acute respiratory distress syndrome (ARDS) and this manoeuvre is now considered a simple and safe method to improve oxygenation. However, the physiological mechanisms causing respiratory function improvement as well as the real clinical benefit are not yet fully understood. The aim of this review is to discuss the physiological and clinical effects of prone positioning in patients with ARDS.The main physiological aims of prone positioning are: 1) to improve oxygenation; 2) to improve respiratory mechanics; 3) to homogenise the pleural pressure gradient, the alveolar inflation and the ventilation distribution; 4) to increase lung volume and reduce the amount of atelectatic regions; 5) to facilitate the drainage of secretions; and 6) to reduce ventilator-associated lung injury.According to the available data, the authors conclude that: 1) oxygenation improves iny70-80% of patients with early acute respiratory distress syndrome; 2) the beneficial effects of oxygenation reduce after 1 week of mechanical ventilation; 3) the aetiology of acute respiratory distress syndrome may markedly affect the response to prone positioning; 4) extreme care is necessary when the manoeuvre is performed; 5) pressure sores are frequent and related to the number of pronations; 6) the supports used to prone and during positioning are different and nonstandardised among centres; and 7) intensive care unit and hospital stay and mortality still remain high despite prone positioning. Eur Respir J 2002; 20: 1017-1028. Acute respiratory distress syndrome (ARDS) is characterised by radiographical diffuse bilateral infiltrates, decreased respiratory compliance, small lung volumes and severe hypoxaemia. Correction of lifethreatening hypoxia and improvement of respiratory mechanics and lung volumes are the main treatment goals. To achieve these ends, it is important to select the most appropriate means of ventilatory support, thereby minimising the damaging effects of mechanical ventilation. Currently, ventilatory support using small tidal volumes and low plateau pressures and respiratory rate, to control arterial carbon dioxide tension (Pa,CO 2 ) and pH, are considered optimal [1]. Moreover, the application of relatively high levels of positive end-expiratory pressure (PEEP) seems to be beneficial in reducing ventilator-associated lung injury (VALI) and improving survival [2]. In 1974, BRYAN [3] suggested that anaesthetised and paralysed patients in the prone position should exhibit better expansion of the dorsal lung regions with a consequent improvement in oxygenation. In 1976, PIEHL and BROWN [4] showed, in a retrospective study, that the prone position improved oxygenation in five patients with ARDS without deleterious effects. One year later, DOUGLAS et al. [5] demonstrated, in a prospective study with a limited group of ARDS patients, that prone positioning could effectively improve oxygenation in ARDS. Starting from these repor...

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Section: Effects On Respiratory Mechanicsmentioning

confidence: 99%

Section: An Overview Of the Literaturementioning

confidence: 99%

Section: An Overview Of the Literaturementioning

confidence: 99%

See 1 more Smart Citation

Prone position in acute respiratory distress syndrome

Pelosi¹,

Brazzi²,

Gattinoni³

2002

European Respiratory Journal

271

167

View full text Add to dashboard Cite

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“…Decreased levels of total proteins in BAL accompained this alleviating effect on lung injury. Since West's accurate descriptions of the physiology of respiration and the ventilation/perfusion zones 12 , position change has been advocated to promote redistribution of gas, recruit alveoli, and redistribute pulmonary blood flow 13 .…”

Section: Discussionmentioning

confidence: 99%

Effects of prone and supine position on oxygenation and inflammatory mediator in a hydrochloric acid-induced lung dysfunction in rats

et al. 2008

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Purpose:To compare the effectiveness of mechanical ventilation of supine versus prone position in hydrochloric acid (HCl)-induced lung dysfunction. Methods: Twenty, adult, male, Wistar-EPM-1 rats were anesthetized and randomly grouped (n=5 animals per group) as follows: CS-MV (mechanical ventilation in supine position); CP-MV (mechanical ventilation in prone position); bilateral instillation of HCl and mechanical ventilation in supine position (HCl+S); and bilateral instillation of HCl and mechanical ventilation in prone position (HCl+P). All groups were ventilated for 180 minutes. The blood partial pressures of oxygen and carbon dioxide were measured in the time points 0 (zero; 10 minutes before lung injury for stabilization), and at the end of times acid injury, 60, 120 and 180 minutes of mechanical ventilation. At the end of experiment the animals were euthanized, and bronchoalveolar lavages (BALs) were taken to determine the contents of total proteins, inflammatory mediators, and lungs wet-to-dry ratios. Results: In the HCl+P group the partial pressure of oxygen increased when compared with HCl+S (128.0±2.9 mmHg and 111.0±6.7 mmHg, respectively) within 60 minutes. TNF-α levels in BAL do not differ significantly in the HCl+P group (516.0±5.9 pg/mL), and the HCl+S (513.0±10.6 pg/mL). Conclusion:The use of prone position improved oxygenation, but did not reduce TNF-α in BAL upon lung dysfunction induced by HCl. Key words: Lung. Respiration, Artificial. Oxygenation. Inflammation Mediators. Rats. RESUMO Objetivo:Comparar os efeitos da ventilação mecânica em posição prona versus supina na disfunção pulmonar induzida por ácido clorídrico (HCl). Métodos: Vinte ratos, adultos, Wistar-EPM-1 foram anestesiados e distribuídos aleatoriamente em grupos (n=5 animais por grupo): CS-MV (controle, ventilado mecanicamente em posição supina); CP-MV (controle, ventilado mecanicamente em posição prona); instilação bilateral de HCl e ventilação mecânica em posição supina (HCl+S) ou ventilação em posição prona (HCl+P). Todos os grupos foram submetidos a ventilação mecânica por 180 minutos. As pressões parciais de oxigênio e dióxido de carbono no sangue arterial foram mensuradas nos tempos Injúria ácida (10 minutos após instilação de HCl), e ao final de cada período após lesão por HCl, 60, 120 e 180 minutos sob ventilação mecânica. Ao final do experimento os animais foram eutanasiados, os pulmões retirados para avaliação do peso úmido em relação ao peso seco do pulmão direito e realizamos o lavado broncoalveolar (BAL) para determinação de proteínas totais e o mediador inflamatório TNF-α. Resultados: No grupo HCl+P a pressão parcial de oxigênio, no tempo de 60 minutos, aumentou quando comparada com o grupo HCl+S (128.0±2.9 e 111.0±6.7 mmHg, respectivamente). Os níveis de TNF-α no lavado broncoalveolar não diferiram de maneira estatisticamente significante quando comparamos os grupos HCl+S (513.0±10.6 pg/mL) versus HCl+P (516.0±5.9 pg/mL). Conclusão: O uso da posição prona melhora a oxigenação, mas não reduz os níveis de BAL ...

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“…São poucos os paraefeitos relacionados à mudança de decúbito; mais comumente, é visto o edema subcutâneo posicional, que ocorre a partir de poucas horas (4 h). São citados, ainda, edema de face, lesão de córnea, extubação acidental, perda de acesso vascular e taquicardia supraventricular [14][15][16][17] .…”

Section: Short-term Effects Of Prone Positioning On the Oxygenation Ounclassified

Efeito a curto prazo da posição prona na oxigenação de crianças em ventilação mecânica

Bruno¹,

Piva²,

García³

et al. 2001

J. Pediatr. (Rio J.)

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Objective: to analyze the short-term effects of prone positioning on the oxygenation of mechanically-ventilated children suffering from severe hypoxemia.Materials and Methods: a prospective, nonrandomized trial (each patient as his/her own control) was conducted between July 1998 and July 1999. Mechanically-ventilated children with peak inspiratory pressure (PIP) greater than or equal to 30 cm H 2 O, FiO 2 greater than or equal to 0.5, and PaO 2 /FiO 2 ratio less than or equal to 200 were included in the study. Each patient was kept in the prone position for two hours, returning to the supine position after this period. Oxygenation was assessed by means of PaO 2 /FiO 2 in the supine position (one hour before prone positioning), one hour after prone positioning, and one hour after returning to the supine position. Patients who presented an increase of at least 20 in PaO 2 /FiO 2 were considered responsive. The results were compared by Student t-test, Friedman test, chi-square test, Fisher's exact test, and confidence interval (CI).Results: eighteen children (10 males), whose mean age was 11.5 +11.5 months, with initial PaO 2 /FiO 2 of 96.06 + 41.78, participated in the study. After one hour in the prone position, 27.7% of the patients (5/18) improved their PaO 2 /FiO 2 ratio (P=0.045). Six of these patients presented reduced lung compliance (four of them had acute respiratory distress syndrome); and twelve patients showed increased airway resistance (six of them presented bronchiolitis). No significant difference was observed between these two groups (reduced lung compliance x increased airway resistance) in terms of age, sex, duration of ventilation prior to change in position, peak inspiratory pressure, FiO 2 , severity of hypoxemia, and outcome.Conclusion: prone positioning during mechanical ventilation of children with severe hypoxemia may improve the PaO 2 /FiO 2 ratio in the first hour.J Pediatr (Rio J) 2001; 77 (5): 361-8: pronation, oxygenation, acute respiratory distress syndrome, pediatric intensive care unit, children, artificial respiration. ResumoObjetivos: analisar o efeito a curto prazo da posição prona na oxigenação de pacientes pediátricos com hipoxemia severa e submetidos a ventilação mecânica.Material e Métodos: ensaio clínico prospectivo, não randomizado, sendo cada paciente o seu próprio controle, realizado no período de julho de 1998 a julho de 1999. Incluídas todas as crianças com diagnóstico de insuficiência respiratória aguda, em ventilação mecânica, com pressão inspiratória positiva (PIP) > 30cm H 2 O e fração de oxigênio inspirada (FiO 2 ) > 0,5, que apresentassem paO 2 / FiO 2 < 200. Os pacientes foram mantidos duas horas na posição prona, retornando, a seguir, à posição supina. Avaliou-se a oxigenação, através da paO 2 /FiO 2 , na posição supina (1 hora antes da mudança de posição), com 1 hora de posição prona e 1 hora após retornar à posição supina. Considerou-se responsivo todo o paciente que apresentasse um aumento de, no mínimo, 20 na paO 2 /FiO 2 . Os resultados foram com...

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Effects of ventilation in ventral decubitus position on respiratory mechanics in adult respiratory distress syndrome

Abstract: We observed an increase in oxygenation and Crs when the patients were turned from the supine to the prone position with the upper thorax and pelvis supported.

Cited by 68 publications

References 36 publications

Prone position in acute respiratory distress syndrome

Prone position in acute respiratory distress syndrome

Effects of prone and supine position on oxygenation and inflammatory mediator in a hydrochloric acid-induced lung dysfunction in rats

Efeito a curto prazo da posição prona na oxigenação de crianças em ventilação mecânica

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