Prone positioning attenuates and redistributes ventilator-induced lung injury in dogs

Broccard, Alain F.; Shapiro, Robert; Schmitz, Laura L.; Adams, Alex B.; Nahum, Avi; Marini, John J.

doi:10.1097/00003246-200002000-00001

Cited by 250 publications

(157 citation statements)

References 35 publications

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“…12,29 For the same tidal volume and PEEP combination, ventilating large animals in the prone position reduces the severity of ventilator-inflicted lung damage. 24,30,31 Using the very high but irrefutable outcome threshold of improved overall mortality, most large clinical trials conducted over the last 20 y were unable to confirm a survival benefit in diverse populations of subjects labeled as having acute lung injury/ARDS. [14][15][16][17] Clearly, not everyone benefits from face-down positioning, yet post-trial subgroup analyses have hinted that certain patient subgroups might indeed benefit from the prone orientation.…”

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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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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“…PP may also reduce lung overdistension [32] and improve alveolar ventilation and lung mechanics, thereby preventing or lessening ventilator-induced lung injury [10]. In addition, PP improves secretion drainage, which is often impaired in intubated patients.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to improving oxygenation, PP has been shown in experimental studies to diminish ventilator-induced lung injury [10], and most clinicians agree that turning patients prone improves secretion drainage [11,12]. Whether these effects protect against VAP is unclear.…”

mentioning

confidence: 99%

Study of prone positioning to reduce ventilator-associated pneumonia in hypoxaemic patients

Mounier

Adrie²,

Français³

et al. 2009

European Respiratory Journal

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The aim of the present study was to examine whether prone positioning (PP) affects ventilator associated-pneumonia (VAP) and mortality in patients with acute lung injury/adult respiratory distress syndrome.2,409 prospectively included patients were admitted over 9 yrs (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) to 12 French intensive care units (ICUs) (OUTCOMEREA). The patients required invasive mechanical ventilation (MV) and had arterial oxygen tension/inspiratory oxygen fraction ratios ,300 during the first 48 h. Controls were matched to PP patients on the PP propensity score (¡10%), MV duration longer than that in PP patients before the first turn prone, and centre.VAP incidence was similar in the PP and control groups (24 versus 13 episodes?1,000 patientdays MV -1 respectively, p50.14). After adjustment, PP did not decrease VAP occurrence (HR 1.64(95% CI 0.70-3.84); p50.25) but significantly delayed hospital mortality (HR 0.56 (95% CI 0.39-0.79); p50.001), without decreasing 28-day mortality (37% in both groups). Post hoc analyses indicated that PP did not protect against VAP but, when used for .1 day, might decrease mortality and benefit the sickest patients (Simplified Acute Physiology Score .50).In ICU patients with hypoxaemic acute respiratory failure, PP had no effect on the risk of VAP. PP delayed mortality without decreasing 28-day mortality. PP .1 day might decrease mortality, particularly in the sickest patients.

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“…Contudo, apesar de tais benefícios, ainda não há evidências concretas que demonstrem diminuição da mortalidade como conseqüência deste posicionamento 3, 14,[21][22][23][24][25][26][27] . Estudo em animais sugeriu que a ventilação durante a posição prona associada à otimização dos parâmetros ventilatórios, através da análise da mecânica pulmonar, torna mais eficaz o suporte ventilatório, porém levando a necessidade de alterações dos parâmetros ventilatórios 28 . Uma vez que a posição prona promove uma série de alterações pulmonares, inclusive na mecânica pulmonar, abre-se a hipótese da necessidade de otimizar os parâmetros ventilatórios após a instalação deste novo decúbito, principalmente do valor da pressão positiva expiratória final (PEEP).…”

Section: Resumo Justificativa E Objetivosunclassified

Ajustes da pressão positiva expiratória final ideal na síndrome do desconforto respiratório agudo na posição prona

Oliveira¹,

Garcia²,

Peres³

et al. 2008

Rev. bras. ter. intensiva

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RESUMO JUSTIFICATIVA E OBJETIVOS:A posição em decúbi-to ventral (posição prona) aplicada em pacientes com síndrome do desconforto respiratório agudo (SDRA), tem demonstrado melhora da oxigenação em mais de 70% dos casos. Uma vez que essa posição promove uma série de alterações pulmonares, inclusive na mecânica pulmonar, abre-se a hipótese da necessidade de otimizar os parâmetros ventilatórios após a instalação deste novo decúbito, principalmente do valor da pressão positiva expiratória final (PEEP). O objetivo deste estudo foi avaliar a influência da posição prona no cálculo da PEEP ideal, titulada pela melhor complacência pulmonar e comparar as alterações pulmonares de mecânica, de oxigenação e de ventilação nas posições supina e prona.

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Prone positioning attenuates and redistributes ventilator-induced lung injury in dogs

Cited by 250 publications

References 35 publications

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

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

Study of prone positioning to reduce ventilator-associated pneumonia in hypoxaemic patients

Ajustes da pressão positiva expiratória final ideal na síndrome do desconforto respiratório agudo na posição prona

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