The effect of prone ventilation on intra-abdominal pressure

Fletcher, Stephen

doi:10.1080/09563070701776570

Cited by 5 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two studies unloaded the abdomen [36,37] while five did not [38-42], and one study did not report on abdominal unloading [43]. Finally, one study randomized abdominal suspension [44].…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies measured IAP during PV in critically ill patients, and another study concerned obese patients during elective surgery (Table 2 ). Two studies unloaded the abdomen [ 36 , 37 ] while five did not [ 38 - 42 ], and one study did not report on abdominal unloading [ 43 ]. Finally, one study randomized abdominal suspension [ 44 ].…”

Section: Resultsmentioning

confidence: 99%

“…They found an improvement in respiratory function with PV and an increase in IAP when turned to prone regardless of suspension or not [ 44 ]. Most recently, in 10 patients with pulmonary ARDS and initial IAP constituting grade II IAH (14.5 mmHg), Fletcher reported a small but statistically significant fall after proning [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Clinical review: Intra-abdominal hypertension: does it influence the physiology of prone ventilation?

et al. 2010

View full text Add to dashboard Cite

Prone ventilation (PV) is a ventilatory strategy that frequently improves oxygenation and lung mechanics in critical illness, yet does not consistently improve survival. While the exact physiologic mechanisms related to these benefits remain unproven, one major theoretical mechanism relates to reducing the abdominal encroachment upon the lungs. Concurrent to this experience is increasing recognition of the ubiquitous role of intra-abdominal hypertension (IAH) in critical illness, of the relationship between IAH and intra-abdominal volume or thus the compliance of the abdominal wall, and of the potential difference in the abdominal influences between the extrapulmonary and pulmonary forms of acute respiratory distress syndrome. The present paper reviews reported data concerning intra-abdominal pressure (IAP) in association with the use of PV to explore the potential influence of IAH. While early authors stressed the importance of gravitationally unloading the abdominal cavity to unencumber the lung bases, this admonition has not been consistently acknowledged when PV has been utilized. Basic data required to understand the role of IAP/IAH in the physiology of PV have generally not been collected and/or reported. No randomized controlled trials or meta-analyses considered IAH in design or outcome. While the act of proning itself has a variable reported effect on IAP, abundant clinical and laboratory data confirm that the thoracoabdominal cavities are intimately linked and that IAH is consistently transmitted across the diaphragm - although the transmission ratio is variable and is possibly related to the compliance of the abdominal wall. Any proning-related intervention that secondarily influences IAP/IAH is likely to greatly influence respiratory mechanics and outcomes. Further study of the role of IAP/IAH in the physiology and outcomes of PV in hypoxemic respiratory failure is thus required. Theories relating inter-relations between prone positioning and the abdominal condition are presented to aid in designing these studies.

show abstract

“…Two studies unloaded the abdomen [36,37] while five did not [38-42], and one study did not report on abdominal unloading [43]. Finally, one study randomized abdominal suspension [44].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical review: Intra-abdominal hypertension: does it influence the physiology of prone ventilation?

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Prone position modifies this situation, and some authors have reported decreased intra-abdominal pressure; (34) in the end, the abdominal wall becomes more rigid, with a resulting increase in intra-abdominal pressure. (35-37) …”

Section: Methodsmentioning

confidence: 99%

Prone position in patients with acute respiratory distress syndrome

Setten¹,

Plotnikow

Accoce

2016

Revista Brasileira De Terapia Intensiva

View full text Add to dashboard Cite

Acute respiratory distress syndrome occupies a great deal of attention in intensive care units. Despite ample knowledge of the physiopathology of this syndrome, the focus in intensive care units consists mostly of life-supporting treatment and avoidance of the side effects of invasive treatments. Although great advances in mechanical ventilation have occurred in the past 20 years, with a significant impact on mortality, the incidence continues to be high. Patients with acute respiratory distress syndrome, especially the most severe cases, often present with refractory hypoxemia due to shunt, which can require additional treatments beyond mechanical ventilation, among which is mechanical ventilation in the prone position. This method, first recommended to improve oxygenation in 1974, can be easily implemented in any intensive care unit with trained personnel.Prone position has extremely robust bibliographic support. Various randomized clinical studies have demonstrated the effect of prone decubitus on the oxygenation of patients with acute respiratory distress syndrome measured in terms of the PaO2/FiO2 ratio, including its effects on increasing patient survival.The members of the Respiratory Therapists Committee of the Sociedad Argentina de Terapia Intensiva performed a narrative review with the objective of discovering the available evidence related to the implementation of prone position, changes produced in the respiratory system due to the application of this maneuver, and its impact on mortality. Finally, guidelines are suggested for decision-making.

show abstract

“…In patients demonstrating no abdominal disease, a minimal, though substantial increase of intra-abdominal pressure without intra-abdominal compartment syndrome occurred as a result of prone positioning during a period of up to 2 h [ 99 , 134 , 135 ] (evidence level 2b). Likewise, no impact on splanchnic perfusion was demonstrated [ 157 , 187 ].…”

Section: Prone Position In Patients With Acute Pulmonary Disordersmentioning

confidence: 99%

S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders

et al. 2015

View full text Add to dashboard Cite

The German Society of Anesthesiology and Intensive Care Medicine (DGAI) commissioneda revision of the S2 guidelines on “positioning therapy for prophylaxis or therapy of pulmonary function disorders” from 2008. Because of the increasing clinical and scientificrelevance the guidelines were extended to include the issue of “early mobilization”and the following main topics are therefore included: use of positioning therapy and earlymobilization for prophylaxis and therapy of pulmonary function disorders, undesired effects and complications of positioning therapy and early mobilization as well as practical aspects of the use of positioning therapy and early mobilization. These guidelines are the result of a systematic literature search and the subsequent critical evaluation of the evidence with scientific methods. The methodological approach for the process of development of the guidelines followed the requirements of evidence-based medicine, as defined as the standard by the Association of the Scientific Medical Societies in Germany. Recently published articles after 2005 were examined with respect to positioning therapy and the recently accepted aspect of early mobilization incorporates all literature published up to June 2014.

show abstract

The effect of prone ventilation on intra-abdominal pressure

Cited by 5 publications

References 8 publications

Clinical review: Intra-abdominal hypertension: does it influence the physiology of prone ventilation?

Clinical review: Intra-abdominal hypertension: does it influence the physiology of prone ventilation?

Prone position in patients with acute respiratory distress syndrome

S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders

Contact Info

Product

Resources

About