Prone position in mechanically ventilated patients with severe acute respiratory failure.

Chatté, G.; Sab, J. M.; Dubois, J. M.; Sirodot, Michel; Gaussorgues, P.; Robert, Dominique

doi:10.1164/ajrccm.155.2.9032181

Cited by 316 publications

(197 citation statements)

References 18 publications

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“…In ARDS patients not responding to recruitment manoeuvres, Grasso et al found that a decreased chest wall compliance limited the transpulmonary gradient, and hence the driving force for recruitment [57], a mechanism likely to explain the failure of recruitment manoeuvres in non-responders in other studies [61,70,71]. Pelosi et al observed that patients with primary ARDS were less responsive to a recruitment manoeuvre [61], which is in concordance with the experimental studies by Kloot et al mentioned before [31].…”

Section: Human Studiessupporting

confidence: 56%

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 Studiessupporting

confidence: 56%

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 consistently quoted response rate is approximately 70%. 38 The more even distribution of trans-alveolar pressure accomplished by the prone-modified chest wall may reduce the impact of stress focusing at the junctions of closed and open alveoli, 39 reduce the tendency for airway opening and closure, allow the use of less PEEP, improve afterload to the right ventricle, 40,41 and permit reduction of potentially toxic concentrations of inspired oxygen. To achieve a survival benefit, it would appear from published data that the patient should be positioned prone for the majority of the day for at least several days.…”

Section: Prone Positioning As a Standard For Ards-promentioning

confidence: 99%

Should Early Prone Positioning Be a Standard of Care in ARDS With Refractory Hypoxemia?

et al. 2016

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Introduction Prone Positioning as a Standard for ARDS-Pro Prone Positioning as a Standard for ARDS-ConFor the past 4 decades, the prone position has been employed as an occasional rescue option for patients with severe hypoxemia unresponsive to conventional measures applied in the supine orientation. Proning offers a high likelihood of significantly improved arterial oxygenation to well selected patients, but until the results of a convincing randomized trial were published, its potential to reduce mortality risk remained in serious doubt. Proning does not benefit patients of all disease severities and stages but may be life-saving for others. Because it requires advanced nursing skills and escalation of monitoring surveillance to deploy safely, its place as an early stage standard of care depends on the definition of that label.

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“…This value was chosen on the basis of the literature, in which other authors have used changes of 10 to 20% in this ratio, or an absolute improvement of 20 mmHg in PaO 2 , to define which patients were responders to PP. 6,7,17,23,27 Using this figure of 15%, most of our patients (78.0%) did improve their oxygenation in PP as early as 30 minutes after the maneuver (65.85% of all patients). Moreover, 62.5% had a continuing response even after changing back to SP.…”

Section: Discussionmentioning

confidence: 70%

Effects of prone position on the oxygenation of patients with acute respiratory distress syndrome

et al. 2006

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CONTEXT AND OBJECTIVE: Acute respiratory distress syndrome (ARDS) is characterized by arterial hypoxemia, and prone position (PP) is one possible management strategy. The objective here was to evaluate the effects of PP on oxygenation. DESIGN AND SETTING: Non-randomized, open, prospective, controlled clinical trial, in a surgical intensive care unit at a tertiary university hospital. METHODS: Forty-one ARDS patients underwent PP for three-hour periods. Arterial partial oxygen pressure (PaO2) was measured immediately before changing to PP, after 30, 60, 120 and 180 minutes in PP and 60 minutes after returning to dorsal recumbent position (DP). The paired-t and Dunnett tests were used. RESULTS: A notable clinical improvement in oxygenation (> 15%) was detected in 78.0% of patients. This persisted for 60 minutes after returning to DP in 56% and lasted for 12 and 48 hours in 53.6% and 46.3%, respectively. Maximum improvement was seen after 30 minutes in 12.5% of responding patients and after 180 minutes in 40.6%. No statistically significant associations between PP response and age, gender, weight, PEEP level, tidal volume, respiratory rate, PaO2/FiO2 or duration of mechanical ventilation were detected. One accidental extubation and four cases of deterioration through oxygenation were detected. The 48-hour mortality rate was 17%. CONCLUSIONS: For a significant number of ARDS patients, PP may rapidly enhance arterial oxygenation and its inclusion for management of severe ARDS is justified. However, it is not a cost-free maneuver and caution is needed in deciding on using PP.

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Prone position in mechanically ventilated patients with severe acute respiratory failure.

Cited by 316 publications

References 18 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?

Should Early Prone Positioning Be a Standard of Care in ARDS With Refractory Hypoxemia?

Effects of prone position on the oxygenation of patients with acute respiratory distress syndrome

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