Hemodynamic impact of prone position. Let’s protect the lung and its circulation to improve prognosis

Vieillard‐Baron, Antoine; Boissier, Florence; Artigas, Antonio

doi:10.1007/s00134-023-07001-2

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…Prone positioning as a treatment for ARDS and a tool to decrease ventilator-induced lung injury is well-described in adults ( 55–58 ). It has also been shown to have a role in unloading the RV and improving right ventriculo-arterial coupling ( 43 ). Proning can decrease PVR and increase cardiac output among adult patients with ARDS ( 44 ).…”

Section: Therapeutic Strategies For Rv Dysfunction During Pardsmentioning

confidence: 99%

“…Moreover, an adult cohort with severe ARDS randomized to prone posture experienced a significantly lower incidence of cardiac arrest relative to those who remained supine ( 55 ). There are several proposed mechanisms for the hemodynamic benefit of prone positioning that culminate in reduced RV afterload ( 43 ). Despite increasing dorsal transpulmonary pressure (as measured by esophageal manometry) ( 59 ), the prone posture may increase overall respiratory system compliance by reducing the ventral-to-dorsal transpulmonary pressure differential ( 60 ).…”

Section: Therapeutic Strategies For Rv Dysfunction During Pardsmentioning

confidence: 99%

“…Despite increasing dorsal transpulmonary pressure (as measured by esophageal manometry) ( 59 ), the prone posture may increase overall respiratory system compliance by reducing the ventral-to-dorsal transpulmonary pressure differential ( 60 ). This improvement in respiratory mechanics reduces driving pressures while increasing the homogeneity of alveolar ventilation ( 43 ), limiting risk of ventilator-induced lung injury and associated RV dysfunction ( 61 , 62 ). Improvements in ventilation and oxygenation associated with more optimal ventilation/perfusion matching would be expected to reduce PVR.…”

Section: Therapeutic Strategies For Rv Dysfunction During Pardsmentioning

confidence: 99%

“…There is also speculation that proning optimizes RV three-dimensional geometry, leading to improved RV systolic function ( 45 ). Though the evidence and mechanisms by which prone positioning promotes reductions in RV stress during ARDS have only been demonstrated in adults (summarized nicely by Vieillard-Baron et al ( 43 )), in the absence of evidence in the pediatric population, prone positioning can be reasonably employed for children with or at risk for acute RV dysfunction in the setting of PARDS.…”

Section: Therapeutic Strategies For Rv Dysfunction During Pardsmentioning

confidence: 99%

See 3 more Smart Citations

Cardiac dysfunction in severe pediatric acute respiratory distress syndrome: the right ventricle in search of the right therapy

Webb,

Burton,

Manchikalapati

et al. 2023

Front. Med.

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Severe acute respiratory distress syndrome in children, or PARDS, carries a high risk of morbidity and mortality that is not fully explained by PARDS severity alone. Right ventricular (RV) dysfunction can be an insidious and often under-recognized complication of severe PARDS that may contribute to its untoward outcomes. Indeed, recent evidence suggest significantly worse outcomes in children who develop RV failure in their course of PARDS. However, in this narrative review, we highlight the dearth of evidence regarding the incidence of and risk factors for PARDS-associated RV dysfunction. While we wish to draw attention to the absence of available evidence that would inform recommendations around surveillance and treatment of RV dysfunction during severe PARDS, we leverage available evidence to glean insights into potentially helpful surveillance strategies and therapeutic approaches.

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Section: Therapeutic Strategies For Rv Dysfunction During Pardsmentioning

confidence: 99%

Section: Therapeutic Strategies For Rv Dysfunction During Pardsmentioning

confidence: 99%

Section: Therapeutic Strategies For Rv Dysfunction During Pardsmentioning

confidence: 99%

Section: Therapeutic Strategies For Rv Dysfunction During Pardsmentioning

confidence: 99%

See 2 more Smart Citations

Cardiac dysfunction in severe pediatric acute respiratory distress syndrome: the right ventricle in search of the right therapy

Webb,

Burton,

Manchikalapati

et al. 2023

Front. Med.

View full text Add to dashboard Cite

show abstract

Prone Positioning and Right Ventricular Protection During Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome

Zochios,

Yusuff,

Antonini

2024

ASAIO Journal

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Positive end-expiratory pressure management in patients with severe ARDS: implications of prone positioning and extracorporeal membrane oxygenation

Boesing,

Rocco,

Luecke

et al. 2024

Crit Care

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The optimal strategy for positive end-expiratory pressure (PEEP) titration in the management of severe acute respiratory distress syndrome (ARDS) patients remains unclear. Current guidelines emphasize the importance of a careful risk–benefit assessment for PEEP titration in terms of cardiopulmonary function in these patients. Over the last few decades, the primary goal of PEEP usage has shifted from merely improving oxygenation to emphasizing lung protection, with a growing focus on the individual pattern of lung injury, lung and chest wall mechanics, and the hemodynamic consequences of PEEP. In moderate-to-severe ARDS patients, prone positioning (PP) is recommended as part of a lung protective ventilation strategy to reduce mortality. However, the physiologic changes in respiratory mechanics and hemodynamics during PP may require careful re-assessment of the ventilation strategy, including PEEP. For the most severe ARDS patients with refractory gas exchange impairment, where lung protective ventilation is not possible, veno-venous extracorporeal membrane oxygenation (V-V ECMO) facilitates gas exchange and allows for a “lung rest” strategy using “ultraprotective” ventilation. Consequently, the importance of lung recruitment to improve oxygenation and homogenize ventilation with adequate PEEP may differ in severe ARDS patients treated with V-V ECMO compared to those managed conservatively. This review discusses PEEP management in severe ARDS patients and the implications of management with PP or V-V ECMO with respect to respiratory mechanics and hemodynamic function.

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Hemodynamic impact of prone position. Let’s protect the lung and its circulation to improve prognosis

Cited by 4 publications

References 18 publications

Cardiac dysfunction in severe pediatric acute respiratory distress syndrome: the right ventricle in search of the right therapy

Cardiac dysfunction in severe pediatric acute respiratory distress syndrome: the right ventricle in search of the right therapy

Prone Positioning and Right Ventricular Protection During Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome

Positive end-expiratory pressure management in patients with severe ARDS: implications of prone positioning and extracorporeal membrane oxygenation

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