Improved Oxygenation in Patients With Acute Respiratory Failure

Douglas, W. W.; Rehder, Kai; Beynen, Froukje M.; Sessler, Alan D.; Marsh, H. Michael

doi:10.1097/00132586-197804000-00020

Cited by 131 publications

(190 citation 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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“…The prone position may be of advantage in severely compromised patients as FRC is better maintained in this position. Furthermore, during controlled ventilation, inspired gas may be delivered specifically to the dorsal lung fields 45 In subjects with severe unilateral lung disease the lateral position with the good lung down will optimise ventilation perfusion matching. 7o Finally, the supine or the erect-forward position will optimise diaphragmatic function in the asthmatic Y…”

Section: Pulmonary Blood Flowmentioning

confidence: 99%

Cardio-respiratory effects of change of body position

Coonan

Hope

1983

Can Anaesth Soc J

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“…[15][16][17] The possible mechanisms underlying this high efficacy of HFNC have been discussed, 4,18 but, to our knowledge, only one recent published study has explored the effects of the therapy on lung volumes. 19 Prone positioning is a maneuver that improves oxygenation and respiratory mechanics in mechanically ventilated patients with acute lung injury [20][21][22][23] and may reduce mortality in patients with severe hypoxemia. 24 The effects of this therapy on regional lung ventilation have been described in non-intubated healthy adult subjects 25 and in preterm infants on CPAP, 26 but its impact on lung volume distribution in adult subjects with HFNC therapy has not been discussed to date.…”

Section: Introductionmentioning

confidence: 99%

Effect of High-Flow Nasal Cannula and Body Position on End-Expiratory Lung Volume: A Cohort Study Using Electrical Impedance Tomography

et al. 2013

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BACKGROUND: Electrical impedance tomography measures changes in lung impedance, which are mainly related to changes in lung volume. We used electrical impedance tomography to investigate the effects of high-flow nasal cannula (HFNC) and body position on global and regional end-expiratory lung impedance variation (⌬EELI). METHODS: Prospective study with 20 healthy adults. Two periods were defined: the first in supine position and the second in prone position. Each period was divided into 3 phases. In the first and the third phases the subjects were breathing ambient air, and in the second HFNC was implemented. Four regions of interest were defined: 2 ventral and 2 dorsal. All men by nature desire to know.-Aristotle, Metaphysics

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Improved Oxygenation in Patients With Acute Respiratory Failure

Cited by 131 publications

References 0 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?

Cardio-respiratory effects of change of body position

Effect of High-Flow Nasal Cannula and Body Position on End-Expiratory Lung Volume: A Cohort Study Using Electrical Impedance Tomography

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