Short-Term Effects of the Prone Positioning Maneuver on Lung and Chest Wall Mechanics in Patients with Acute Respiratory Distress Syndrome

Riad, Zakaria; Mezidi, Mehdi; Subtil, Fabien; Louis, Bruno; Guérin, Claude

doi:10.1164/rccm.201709-1853le

Cited by 31 publications

(38 citation statements)

References 8 publications

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“…Pelosi et al found that chest wall compliance significantly decreased in PP from SP [ 27 ]. In two previous studies, we also found an increase in Est,cw in PP [ 25 , 28 ] at 0° inclination in both positions, as Pelosi et al [ 27 ]. Therefore, the inclination in SP and PP should be taken into account for interpreting the effect of PP on Est,cw.…”

Section: Discussionsupporting

confidence: 87%

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Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome

Mezidi

Parrilla

Yonis

et al. 2018

Ann. Intensive Care

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BackgroundIn acute respiratory distress syndrome (ARDS) patients, it has recently been proposed to set positive end-expiratory pressure (PEEP) by targeting end-expiratory transpulmonary pressure. This approach, which relies on the measurement of absolute esophageal pressure (Pes), has been used in supine position (SP) and has not been investigated in prone position (PP). Our purposes were to assess Pes-guided strategy to set PEEP in SP and in PP as compared with a PEEP/FIO2 table and to explore the early (1 h) and late (16 h) effects of PP on lung and chest wall mechanics.ResultsWe performed a prospective, physiologic study in two ICUs in university hospitals on ARDS patients with PaO2/FIO2 < 150 mmHg. End-expiratory Pes (Pes,ee) was measured in static (zero flow) condition. Patients received PEEP set according to a PEEP/FIO2 table then according to the Pes-guided strategy targeting a positive (3 ± 2 cmH2O) static end-expiratory transpulmonary pressure in SP. Then, patients were turned to PP and received same amount of PEEP from PEEP/FIO2 table then Pes-guided strategy. Respiratory mechanics, oxygenation and end-expiratory lung volume (EELV) were measured after 1 h of each PEEP in each position. For the rest of the 16-h PP session, patients were randomly allocated to either PEEP strategy with measurements done at the end. Thirty-eight ARDS patients (27 male), mean ± SD age 63 ± 13 years, were included. There were 33 primary ARDS and 26 moderate ARDS. PaO2/FIO2 ratio was 120 ± 23 mmHg. At same PEEP/FIO2 table-related PEEP, Pes,ee averaged 9 ± 4 cmH2O in both SP and PP (P = 0.88). With PEEP/FIO2 table and Pes-guided strategy, PEEP was 10 ± 2 versus 12 ± 4 cmH2O in SP and 10 ± 2 versus 12 ± 5 cmH2O in PP (PEEP strategy effect P = 0.05, position effect P = 0.96, interaction P = 0.96). With the Pes-guided strategy, chest wall elastance increased regardless of position. Lung elastance and transpulmonary driving pressure decreased in PP, with no effect of PEEP strategy. Both PP and Pes-guided strategy improved oxygenation without interaction. EELV did not change with PEEP strategy. At the end of PP session, respiratory mechanics did not vary but EELV and PaO2/FIO2 increased while PaCO2 decreased.ConclusionsThere was no impact of PP on Pes measurements. PP had an immediate improvement effect on lung mechanics and a late lung recruitment effect independent of PEEP strategy.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0434-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 87%

“…Another explanation may be that we compared SP30° to PP0°–15°. Pes,ee decreased by 2 cmH 2 O between SP0° and PP0° in ARDS patients [ 25 ], as in normal subjects experiencing spine surgery [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome

Mezidi

Parrilla

Yonis

et al. 2018

Ann. Intensive Care

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“…Lateral position was associated with an immediate rise in airway resistance by 2 cmH 2 O/L/s and in chest wall and lung elastance by 3 and 2 cmH 2 O/L, respectively. The changes were similar in left or right lateral position (16).…”

Section: Transient Lateral Positionmentioning

confidence: 60%

“…It should be noted that in the study by Mentzelopoulos et al (21) the increase in prone was statistically significant from supine only for tidal volume greater than 0.6 L. Whilst chest wall elastance is not commonly measured, respiratory system elastance or compliance (=1/elastance) can be measured in routine in ARDS patients. The results regarding the change in respiratory system compliance in prone position in ARDS patients are not consistent across the eight studies reported over the last 20 years (16,(19)(20)(21)(24)(25)(26)(27), some studies showing an increase and others no change or a decrease ( Table 1). Assuming a systematic increase in chest wall elastance in prone, one would conclude that lung elastance would not change, increase or decrease if respiratory system elastance decreases by the © Annals of Translational Medicine.…”

Section: Chest Wall Elastancementioning

confidence: 84%

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Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients

Mezidi

Guérin

2018

Ann. Transl. Med

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Changes in the body position of patients receiving mechanical ventilation in intensive care unit are frequent. Contrary to healthy humans, little data has explored the physiological impact of position on respiratory mechanics. The objective of present paper is to review the available data on the effect of changing body position on respiratory mechanics in ICU patients receiving mechanical ventilation. Supine position (lying flat) or lateral position do not seem beneficial for critically ill patients in terms of respiratory mechanics. The sitting position (with thorax angulation >30° from the horizontal plane) is associated with improvement of functional residual capacity (FRC), oxygenation and reduction of work of breathing. There is a critical angle of inclination in the seated position above which the increase in abdominal pressure contributes to increase chest wall elastance and offset the increase in FRC. The impact of prone position on respiratory mechanics is complex, but the increase in chest wall elastance is a central mechanism. To sum up, both sitting and prone positions provides beneficial impact on respiratory mechanics of mechanically ventilated patients as compared to supine position.

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Is the Prone Position Helpful During Spontaneous Breathing in Patients With COVID-19?

Telias

Katira

Brochard

2020

JAMA

112

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to opioid reduction. 9 A service that likely has substantial harms for some, and small benefit for few under the most generous assumptions, should be held to the same standards as other preventive services, regardless of whether it is a laboratory test that leads to an invasive treatment or a series of questions that lead to counseling and referral.Screening for drug use is reasonable to consider in clinical practice, but it is not evidence-based for improving health. These observations should serve as an important call for the development and study of new strategies to identify and address drug use in ways that can reduce related harms of such use.

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Short-Term Effects of the Prone Positioning Maneuver on Lung and Chest Wall Mechanics in Patients with Acute Respiratory Distress Syndrome

Cited by 31 publications

References 8 publications

Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome

Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome

Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients

Is the Prone Position Helpful During Spontaneous Breathing in Patients With COVID-19?

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