Short-term effects of prone position  in critically ill patients with acute respiratory distress syndrome

Blanch, Lluís; Mancebo, Jordi; Pérez, Miguel Ángel Muñoz; Martínez, M.; Mas, Arantxa; Betbese, A. J.; Joseph, D.; Ballús, J.; Lucangelo, Umberto; Bak, E.

doi:10.1007/s001340050453

Cited by 175 publications

(109 citation statements)

References 31 publications

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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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“…10 Moreover, patients with chronic heart failure because of CAD prefer the right lateral decubitus position for significantly longer periods of time than either the left lateral decubitus or supine position, because the sympathetic nervous modulation is most attenuated in this position. 11,12 Modern medical research has found that the prone position can improve the arterial oxygen tension in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), [13][14][15][16][17][18] and is one of the suitable positions used during general or spinal anesthesia. 19,20 ALI and ARDS are severe clinical conditions that are associated with severe oxygenation failure and very high mortality rate.…”

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confidence: 99%

Comparison of Effect of 5 Recumbent Positions on Autonomic Nervous Modulation in Patients With Coronary Artery Disease

Yang

Chen

Kuo

2008

Circ J

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BackgroundThis study compared the effect of 5 recumbent positions on cardiac autonomic nervous modulation in patients with coronary artery disease (CAD). Methods and ResultsSpectral heart rate variability analysis was performed on 33 CAD patients and 17 patients with patent coronary arteries in random order in 5 positions; namely, supine, right lateral decubitus, left lateral decubitus, left prone and right prone positions. In the right lateral decubitus position, the vagal modulation was the highest and the sympathetic modulation was the lowest among the 5 recumbent positions in the control group. In the CAD patients, the vagal modulation in the supine position was significantly lower than that in the other 4 positions. The lower the normalized high-frequency power (nHFP) in the supine position, the larger the percent age increase in nHFP when the position was changed from supine to another recumbent position in both CAD patients and controls. There was no significant change in the respiratory rate when the position was changed from supine to any of the other 4 positions. Conclusions Right lateral decubitus position leads to the highest vagal modulation in the controls, whereas the supine position leads to the lowest vagal modulation in the CAD patients. In addition to the right lateral decubitus position, both the right and left prone positions can be used as a vagal enhancer in patients with CAD as compared with supine, especially for those patients who have severely reduced cardiac vagal modulation while supine. (Circ J 2008; 72: 902 -908)

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“…Com relação aos parâmetros ventilatórios utilizados nos três momentos da pesquisa (Pinsp, f, FiO 2 , Vt, e Ve), não foram observadas modificações significativas em nenhuma das fases propostas. Porém, ao relacioná-los isoladamente notou-se que: quanto maior o valor da PEEP e menor volume-corrente, complacência estáti-ca, pH, PaO 2 , e SaO 2 maior a mortalidade 15,22,34,[35][36][37][38][39][40][41][42][43][44] . Optou-se em realizar o protocolo iniciando na posição supina, pela facilidade de todos os pacientes estarem nesta posição, no entanto se tivessem sido aleatorizados e alguns iniciassem o estudo na posição prona, talvez os resultados pudessem ser diferentes do exposto pela diminuição do efeito carry-over ou de evolução temporal da doença.…”

Section: Discussionunclassified

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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Short-term effects of prone position in critically ill patients with acute respiratory distress syndrome

Abstract: Turning critically ill, severely hypoxemic patients from the supine to the prone position is a safe and useful therapeutic intervention. Our data suggest that prone positioning should be carried out early in the course of ARDS.

Cited by 175 publications

References 31 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?

Comparison of Effect of 5 Recumbent Positions on Autonomic Nervous Modulation in Patients With Coronary Artery Disease

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

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