Document Detail


Influence of prone position on gastric mucosal-arterial PCO2 gradients.
MedLine Citation:
PMID:  11534573     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the effects of mechanical ventilation in the prone position on gastric mucosal-arterial PCO2 gradients. DESIGN: Prospective clinical study. SETTING: Intensive care unit in a university clinic. PATIENTS: Twenty-five patients requiring mechanical ventilation. The physician in charge indicated the turning manoeuver for the individual patient. MEASUREMENTS/RESULTS: In addition to routine measurements of global hemodynamics and gas exchange we determined: 1) intragastric pressure; and 2) gastric mucosal-arterial PCO2 difference. After a baseline measurement in the supine position patients were turned to the prone position. After 60', 120', a median of 6.5 h (2-10 h) in the prone position, and again after 60' in the supine position, all measurements were repeated. Global hemodynamics remained unaltered throughout the study. While gastric mucosal-arterial PCO2 gradients did not change significantly during the first 60 min in the prone position, they significantly increased during the following 60 min [median/percentile: baseline: 6 (1 to -3); 60': 7 (15-5); 120': 13 (20-8) mmHg]. The median intragastric pressure was not significantly affected [baseline: 10 (13-5); 60': 12 (16-8); 120': 11 (13-7) mmHg], but 9 of the 11 patients in whom intragastric pressure increased during the first 60 min in the prone position also showed significantly increased PCO2 gradients (P < 0.01). CONCLUSION: Mechanical ventilation in the prone position may be affiliated with increased tonometric gastric mucosal-arterial PCO2 gradients depending on the effect on intraabdominal pressure. Measuring intraabdominal pressure and/or gastric mucosal PCO2 via a nasogastric tube therefore may help to detect adverse effects of this ventilatory strategy.
Authors:
P Kiefer; A Morin; C Putzke; H Wiedeck; M Georgieff; P Radermacher
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Intensive care medicine     Volume:  27     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-09-05     Completed Date:  2002-01-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1227-30     Citation Subset:  IM    
Affiliation:
Universität Ulm, Universitätsklinik für Anästhesiologie, Donau, Germany. Peter.Kiefer@medizin.uni-ulm.de
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Carbon Dioxide / blood*
Gastric Mucosa / blood supply*,  metabolism*
Hemodynamics
Humans
Partial Pressure
Prone Position*
Prospective Studies
Pulmonary Gas Exchange
Respiration, Artificial / methods*
Splanchnic Circulation*
Statistics, Nonparametric
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

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


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