Document Detail

Comparison of prone positioning and high-frequency oscillatory ventilation in patients with acute respiratory distress syndrome.
MedLine Citation:
PMID:  16215365     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Both prone position and high-frequency oscillatory ventilation (HFOV) have the potential to facilitate lung recruitment, and their combined use could thus be synergetic on gas exchange. Keeping the lung open could also potentially be lung protective. The aim of this study was to compare physiologic and proinflammatory effects of HFOV, prone positioning, or their combination in severe acute respiratory distress syndrome (ARDS). DESIGN:: Prospective, comparative randomized study. SETTING: A medical intensive care unit. PATIENTS: Thirty-nine ARDS patients with a Pao2/Fio2 ratio <150 mm Hg at positive end-expiratory pressure > or =5 cm H2O. INTERVENTIONS: After 12 hrs on conventional lung-protective mechanical ventilation (tidal volume 6 mL/kg of ideal body weight, plateau pressure not exceeding the upper inflection point, and a maximum of 35 cm H2O; supine-CV), 39 patients were randomized to receive one of the following 12-hr periods: conventional lung-protective mechanical ventilation in prone position (prone-CV), HFOV in supine position (supine-HFOV), or HFOV in prone position (prone-HFOV). MEASUREMENTS AND MAIN RESULTS: Prone-CV (from 138 +/- 58 mm Hg to 217 +/- 110 mm Hg, p < .0001) and prone-HFOV (from 126 +/- 40 mm Hg to 227 +/- 64 mm Hg, p < 0.0001) improved the Pao2/Fio2 ratio whereas supine-HFOV did not alter the Pao2/Fio2 ratio (from 134 +/- 57 mm Hg to 138 +/- 48 mm Hg). The oxygenation index ({mean airway pressure x Fio2 x 100}/Pao2) decreased in the prone-CV and prone-HFOV groups and was lower than in the supine-HFOV group. Interleukin-8 increased significantly in the bronchoalveolar lavage fluid (BALF) in supine-HFOV and prone-HFOV groups compared with prone-CV and supine-CV. Neutrophil counts were higher in the supine-HFOV group than in the prone-CV group. CONCLUSIONS: Although HFOV in the supine position does not improve oxygenation or lung inflammation, the prone position increases oxygenation and reduces lung inflammation in ARDS patients. Prone-HFOV produced similar improvement in oxygenation like prone-CV but was associated with higher BALF indexes of inflammation. In contrast, supine-HFOV did not improve gas exchange and was associated with enhanced lung inflammation.
Laurent Papazian; Marc Gainnier; Valérie Marin; Stéphane Donati; Jean-Michel Arnal; Didier Demory; Antoine Roch; Jean-Marie Forel; Pierre Bongrand; Fabienne Brégeon; Jean-Marie Sainty
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  33     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-10     Completed Date:  2005-12-23     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2162-71     Citation Subset:  AIM; IM    
Service de Réanimation Médicale, Hôpital Sainte-Marguerite, Faculté de Médecine de Marseille, Université de la Méditerranée, Marseille, France.
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MeSH Terms
Blood Gas Analysis
Bronchoalveolar Lavage Fluid / chemistry
High-Frequency Ventilation*
Inflammation Mediators / metabolism
Middle Aged
Prone Position*
Prospective Studies
Pulmonary Gas Exchange / physiology*
Respiratory Distress Syndrome, Adult / metabolism,  physiopathology*,  therapy*
Respiratory Mechanics
Supine Position
Reg. No./Substance:
0/Inflammation Mediators
Comment In:
Crit Care Med. 2005 Oct;33(10):2407-8   [PMID:  16215399 ]
Crit Care Med. 2006 May;34(5):1578; author reply 1578-9   [PMID:  16633274 ]

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