Document Detail


Prone positioning, systemic hemodynamics, hepatic indocyanine green kinetics, and gastric intramucosal energy balance in patients with acute lung injury.
MedLine Citation:
PMID:  11819000     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the effects of prone positioning on systemic hemodynamics, intra-abdominal pressure (IAP), plasma disappearance rate of indocyanine green (PDR(ICG)), and gastric intramucosal to arterial PCO2 difference (Pi-aCO2). DESIGN AND SETTING: Prospective randomized study in the intensive care unit of a university hospital. PATIENTS: 12 mechanically ventilated, hemodynamically stable patients with acute lung injury. INTERVENTION: Positioning supine and prone for 3 h in random order. MEASUREMENTS: Systemic hemodynamics were determined by transpulmonary double-indicator dilution technique using an integrating fiberoptic monitoring system. The same monitoring system was used to measure PDR(ICG). IAP was measured in the urinary bladder and gastric intramucosal PCO2 was evaluated by automated recirculation gas tonometry. RESULTS: IAP increased from 10 +/-3 in the supine to 13+/-4 mmHg in the prone position. Cardiac index increased from 3.8+/-0.9 (supine) to 4.2+/-0.6 l/m(2) per minute (prone), mean arterial pressure from 75+/-10 (supine) to 81+/-11 mmHg (prone), PaO2/FIO2 from 194+/-66 (supine) to 269+/-68 mmHg (prone), and oxygen delivery from 558+/-122 (supine) to 620+/-74 ml/m(2) per minute (prone). No other parameters, including PDR(ICG) and Pi-aCO2, differed between the two positions. CONCLUSIONS: Prone positioning in mechanically ventilated patients with acute lung injury, despite a small increase in IAP, does not negatively affect the hepatic capacity to eliminate ICG and gastric intramucosal energy balance when systemic blood flow and oxygenation are improved.
Authors:
Rudolf Hering; Ralph Vorwerk; Hermann Wrigge; Jörg Zinserling; Stefan Schröder; Tilman von Spiegel; Andreas Hoeft; Christian Putensen
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2001-12-04
Journal Detail:
Title:  Intensive care medicine     Volume:  28     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-03-06     Completed Date:  2002-03-27     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:  53-8     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. hering@uni-bonn.de
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adolescent
Adult
Aged
Coloring Agents
Energy Metabolism
Female
Gastric Mucosa / metabolism
Hemodynamics*
Humans
Indocyanine Green / pharmacokinetics*
Liver / metabolism*
Male
Middle Aged
Prone Position
Respiratory Distress Syndrome, Adult / classification,  therapy*
Supine Position
Chemical
Reg. No./Substance:
0/Coloring Agents; 3599-32-4/Indocyanine Green

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


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