Document Detail

Prone position reduces lung stress and strain in severe acute respiratory distress syndrome.
MedLine Citation:
PMID:  15738300     Owner:  NLM     Status:  MEDLINE    
The present authors hypothesised that in severe acute respiratory distress syndrome (ARDS), pronation may reduce ventilator-induced overall stress (i.e. transpulmonary pressure (P(L))) and strain of lung parenchyma (i.e. tidal volume (V(T))/end-expiratory lung volume (EELV) ratio), which constitute major ventilator-induced lung injury determinants. The authors sought to determine whether potential pronation benefits are maintained in post-prone semirecumbent (SR(PP)) posture under pressure-volume curve-dependent optimisation of positive end-expiratory pressure (PEEP). A total of 10 anesthetised/paralysed, mechanically ventilated (V(T) = 9.0+/-0.9 predicted body weight; flow = 0.91+/-0.04 L.s(-1); PEEP = 9.4+/-1.3 cmH(2)O) patients with early/severe ARDS were studied in pre-prone semirecumbent (SR(BAS)), prone, and SR(PP) positions. Partitioned respiratory mechanics were determined during iso-flow (0.91 L.s(-1)) experiments (V(T) varied within 0.2-1.0 L), along with haemodynamics, gas exchange, and EELV. Compared with SR(BAS), pronation/SR(PP) resulted in reduced peak/plateau P(L) at V(T)s> or =0.6 L; static lung elastance and additional lung resistance decreased and chest wall elastance (in prone position) increased; EELV increased (23-33%); V(T)/EELV decreased (27-33%); arterial oxygen tension/inspiratory oxygen fraction and arterial carbon dioxide tension improved (21-43/10-14%, respectively), and shunt fraction/physiological dead space decreased (21-50/20-47%, respectively). In early/severe acute respiratory distress syndrome, pronation under positive end-expiratory pressure optimisation may reduce ventilator-induced lung injury risk. Pronation benefits may be maintained in post-prone semirecumbent position.
S D Mentzelopoulos; C Roussos; S G Zakynthinos
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The European respiratory journal     Volume:  25     ISSN:  0903-1936     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-03-01     Completed Date:  2005-07-12     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  534-44     Citation Subset:  IM    
University of Athens Medical School, Dept of Intensive Care Medicine, Attikon University Hospital, Athens, Greece.
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MeSH Terms
Esophagus / physiopathology
Lung / physiopathology*
Lung Volume Measurements
Middle Aged
Positive-Pressure Respiration
Prone Position*
Pulmonary Gas Exchange
Respiratory Distress Syndrome, Adult / complications,  physiopathology*,  therapy*
Respiratory Mechanics
Stress, Physiological / etiology,  physiopathology*,  therapy*
Trachea / physiopathology
Treatment Outcome

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