Document Detail


Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome.
MedLine Citation:
PMID:  16896856     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Supine position may contribute to the loss of aerated lung volume in patients with acute respiratory distress syndrome (ARDS). We hypothesized that verticalization increases lung volume and improves gas exchange by reducing the pressure surrounding lung bases. DESIGN AND SETTING: Prospective observational physiological study in a medical ICU. SUBJECTS AND INTERVENTION: In 16 patients with ARDS we measured arterial blood gases, pressure-volume curves of the respiratory system recorded from positive-end expiratory pressure (PEEP), and changes in lung volume in supine and vertical positions (trunk elevated at 45 degrees and legs down at 45 degrees ). MEASUREMENTS AND RESULTS: Vertical positioning increased PaO(2) significantly from 94+/-33 to 142+/-49 mmHg, with an increase higher than 40% in 11 responders. The volume at 20 cmH(2)O measured on the PV curve from PEEP increased using the vertical position only in responders (233+/-146 vs. -8+/-9 1ml in nonresponders); this change was correlated to oxygenation change (rho=0.55). End-expiratory lung volume variation from supine to vertical and 1 h later back to supine, measured in 12 patients showed a significant increase during the 1-h upright period in responders (n=7) but not in nonresponders (n=5; 215+/-220 vs. 10+/-22 ml), suggesting a time-dependent recruitment. CONCLUSIONS: Vertical positioning is a simple technique that may improve oxygenation and lung recruitment in ARDS patients.
Authors:
Jean-Christophe M Richard; Salvatore Maurizio Maggiore; Jordi Mancebo; François Lemaire; Bjorn Jonson; Laurent Brochard
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Publication Detail:
Type:  Journal Article     Date:  2006-08-01
Journal Detail:
Title:  Intensive care medicine     Volume:  32     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-10-02     Completed Date:  2007-03-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1623-6     Citation Subset:  IM    
Affiliation:
Rouen University Hospital Charles Nicolle, Medical Intensive Care Unit, UPRES EA 38 30, 1 rue de Germont, 76031 Rouen, France. Jean-Christophe.Richard@chu-rouen.fr
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MeSH Terms
Descriptor/Qualifier:
Blood Gas Analysis
Humans
Positive-Pressure Respiration
Posture*
Prospective Studies
Pulmonary Gas Exchange*
Respiratory Distress Syndrome, Adult / physiopathology*
Statistics, Nonparametric
Tidal Volume

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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