Prone position improves expiratory airway mechanics in severe chronic bronchitis

Mentzelopoulos, Spyros D.

doi:10.1183/09031936.05.00094704

Cited by 9 publications

(27 citation statements)

References 37 publications

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“…In COPD, gas exchange disturbances may be partially explained by enhanced ventilation heterogeneity [5][6][7]. Alternatively, prone position probably causes a more uniform distribution of ventilation [1,2]. Thus, the current authors hypothesised that in severely hyperinflated COPD patients, pronation effects may be maximised and this could be primarily reflected in an increase in effective alveolar ventilation causing a significant decrease in Pa,CO 2 .…”

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confidence: 99%

“…Carbon dioxide arterial tension (Pa,CO 2 ) does not decrease significantly [1][2][3]. Pronation effects on expiratory resistance and hyperinflation were explained by a potentially more homogenous distribution of alveolar septal tension exerted on airway walls [2].…”

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confidence: 99%

“…Such levels of PEEPi,rs have been measured during early (duration ,36 h) controlled ventilation [4]. In two prior studies [1,2], there were three patients with PEEPi,rs .12 cmH 2 O determined during early controlled ventilation. In these patients, prone position versus semirecumbent had resulted in the maximal observed Pa,CO 2 drop of 18.1-22.0% and a concurrent drop of 42.3-48.4% in additional lung resistance.…”

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confidence: 99%

“…The current authors also sought to further elucidate the mechanisms underlying pronation effects [2]. Therefore, in addition to respiratory mechanics, lung volumes and gas exchange [1,2], the present authors studied the effects of body posture on inspiratory pressure-volume (P-V) curves, as it was anticipated that pronation effects would be reflected by changes in P-V curve characteristics.…”

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confidence: 99%

“…n chronic obstructive pulmonary disease (COPD), prone position versus semirecumbent increases lung compliance, reduces airway and additional lung resistance, attenuates dynamic hyperinflation and improves oxygenation [1][2][3]. Carbon dioxide arterial tension (Pa,CO 2 ) does not decrease significantly [1][2][3].…”

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confidence: 99%

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Static pressure-volume curves and body posture in severe chronic bronchitis

Mentzelopoulos

Sigala²,

Roussos³

et al. 2006

European Respiratory Journal

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Based on prior data, the current authors hypothesised that beneficial pronation effects on gas exchange and respiratory mechanics might be maximised in severely hyperinflated chronic bronchitis patients. The current authors also sought to elucidate underlying mechanisms and to determine whether pronation effects are reflected by postural changes in inspiratory pressure-volume (P-V) curve characteristics.A total of 16 mechanically ventilated patients (for 16-36 h) with chronic bronchitis exacerbation were studied in pre-prone semirecumbent (SREC), prone and post-prone SREC postures. Static respiratory system intrinsic positive end-expiratory pressure (PEEPi,rs) was .12 cmH 2 O. Haemodynamics, partitioned respiratory mechanics, gas exchange, and lung volumes were determined at zero external positive end-expiratory pressure. P-V curves were constructed from functional residual capacity.End-expiratory lung volume exceeded opening volume. Prone position versus pre-prone SREC resulted in 20% reduced pressure at the lower inflection point (LIP) and 17% increased volume at the upper inflection point of the lung P-V curve, improved lung mechanics and volumes, oxygenation, and carbon dioxide arterial tension (Pa,CO 2 ). In multiple linear regression, postural decreases in PEEPi,rs and additional lung resistance independently predicted postural decreases in lung LIP pressure and Pa,CO 2 , respectively.In conclusion, in severely hyperinflated patients, pronation reduces lung lower inflection point pressure and increases lung upper inflection point volume. Pronation effects on ventilation homogeneity and carbon dioxide arterial tension are maximised, implying that pronation can be useful during early controlled ventilation.

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