Sigh in Supine and Prone Position during Acute Respiratory Distress Syndrome

Abstract

A way to achieve a more even distribution of lung inflation (13-15).Hence, we designed this study of patients with early ARDS Keywords: acute lung injury; acute respiratory distress syndrome; meto test the hypothesis that prone position enhances the physichanical ventilation; recruitment; end-expiratory lung volume ologic effect of a RM. Our hypothesis is supported by the findings of a canine model of ALI showing that a lower PEEP Mechanical ventilation with low tidal volume may prevent is required in the prone than in the supine position to preserve ventilator-induced lung injury (VILI) and increased survival the effects of a RM (16). Our hypothesis is clinically relevant of patients with acute lung injury/acute respiratory distress because approximately 50% of ARDS patients do not exhibit syndrome (ALI/ARDS) (1). However, using low ventilatory a satisfactory response to a RM in the supine position (6, 7). volumes may also limit alveolar inflation and promote atelectasis and hypoxemia (2, 3). Thus, "lung protective" strategies METHODS to ventilate patients with ALI/ARDS have to consider two potentially conflicting goals: preventing VILI and reinflating Study Population collapsed alveoli. Servo ventilator 300 C (Siemens, Solna, Sweden). All had indwelling of RMs include the following: (1 ) the concomitant use of arterial and pulmonary artery catheters. The study included the following periods: baseline supine (2 hours), sighs in supine (1 hour), second baseline supine (1 hour), baseline prone (2 hours), sigh in prone (1 hour), and second baseline prone (1 hour). Measurements were taken at the end of each period, and the entire study lasted approximately 8 (Received in original form March 13, 2002; accepted in final form November 27, 2002) hours. Patients were positioned prone as previously described (14).Correspondence and requests for reprints should be addressed to Luciano GattiMechanical ventilation was provided using a tidal volume of approxinoni, Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, mately 7 ml/kg of actual body weight to maintain an upper limit of This article has an online supplement, which is accessible from this issue's table because it was associated with a decreased compliance of the chest wall of contents online at www.atsjournals.org and was not deemed to reflect an increase in transpulmonary pressure.

A comparative study of supine lying, side lying and prone positioning on oxygen saturation, in mechanically ventilated patients, in acute respiratory failure

“…It is supported by the findings of Pelosi et al 1998 that there is increase in PO2/FIO2 more than 20. 21 The restricted movement of more freely movable sternal part of the rib cage along with decreased compression of the lungs by the heart and decreased vertical plural gradient allows preferential distribution of tidal volume to the dorsal regions of the lung. There is reduction in mean positive airway pressure.…”

Variable positive end-expiratory pressure can maintain oxygenation in experimental acute respiratory distress syndrome induced by oleic acid in dogs

“…There is no doubt that initial lung recruitment rapidly improves oxygenation, which will only be maintained when using high PEEP levels (25)(26)(27)(28)(29). These observations were also made in ARDS patients with increased functional residual capacity and end-expiratory lung volume after the utilization of lung inflation or with sighs associated with PEEP (16,30,31). It is known that low PEEP in ARDS patients cannot improve oxygenation (1,(6)(7)(8)(9).…”

Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo

“…Pelosi et al (39) ventilated 10 ARDS patients showing that the mechanisms for PaO 2 increases in prone position are different from the ARM mechanisms. In this trial, they correlated the final expiratory lung volume and static lung complacency with PaO 2 increase and found a positive correlation between these and recruitment maneuver, while there was no relationship between increased final expiratory lung volume and significant PaO 2 increase in prone position.…”