Copyright ©ERS Journals Ltd 2005 doi: 10.1183/09031936.05.00105804
Prone position reduces lung stress and strain in severe acute respiratory distress syndrome1 University of Athens Medical School, Dept of Intensive Care Medicine, Attikon University Hospital, and 2 University of Athens Medical School, Dept of Intensive Care Medicine, Evaggelismos General Hospital, Athens, Greece CORRESPONDENCE: S. D. Mentzelopoulos, 12 Ioustinianou Street, GR-11473, Athens, Greece. Fax: 30 2103218493. E-mail: sdm@hol.gr Keywords: Acute respiratory distress syndrome, gas exchange, lung recruitment, mechanical ventilation, mechanics of the respiratory system, prone position
Received: September 9, 2004
The present authors hypothesised that in severe acute respiratory distress syndrome (ARDS), pronation may reduce ventilator-induced overall stress (i.e. transpulmonary pressure (PL)) and strain of lung parenchyma (i.e. tidal volume (VT)/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 (SRPP) posture under pressure-volume curve-dependent optimisation of positive end-expiratory pressure (PEEP).
A total of 10 anesthetised/paralysed, mechanically ventilated (VT = 9.0±0.9 mL·kg1 predicted body weight; flow = 0.91±0.04 L·s1; PEEP = 9.4±1.3 cmH2O) patients with early/severe ARDS were studied in pre-prone semirecumbent (SRBAS), prone, and SRPP positions. Partitioned respiratory mechanics were determined during iso-flow (0.91 L·s1) experiments (VT varied within 0.21.0 L), along with haemodynamics, gas exchange, and EELV.
Compared with SRBAS, pronation/SRPP resulted in reduced peak/plateau PL at VTs
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.
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