Beneficial effects of the prone position on the incidence of barotrauma in oleic acid‐induced lung injury under continuous positive pressure ventilation

Du, Hong-Lin; Yamada, Yosuke; Orii, Ryo; Suzuki, Shinya; Sawamura, Shigehito; Suwa, Kunio; Hanaoka, Kazuo

doi:10.1111/j.1399-6576.1997.tb04769.x

Cited by 15 publications

(9 citation statements)

References 18 publications

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“…Moreover, while the injury in the supine position was distributed mainly to the dependent lung regions, where collapsing and reinflating phenomena are more likely to occur, in the prone position lung injury was not only reduced in total, but was more homogeneously distributed. Similar findings were obtained by other authors [33] who observed a lower incidence of pneumothorax in dogs kept prone. In conclusion, prone positioning can exert a protective effect on the mechanically ventilated injured lung.…”

Section: Ventilator-associated Lung Injury and The Prone Positionsupporting

confidence: 92%

Prone position in acute respiratory distress syndrome

Pelosi¹,

Brazzi²,

Gattinoni³

2002

Eur Respir J

273

167

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In the last few years prone positioning has been used increasingly in the treatment of patients with acute respiratory distress syndrome (ARDS) and this manoeuvre is now considered a simple and safe method to improve oxygenation. However, the physiological mechanisms causing respiratory function improvement as well as the real clinical benefit are not yet fully understood. The aim of this review is to discuss the physiological and clinical effects of prone positioning in patients with ARDS.The main physiological aims of prone positioning are: 1) to improve oxygenation; 2) to improve respiratory mechanics; 3) to homogenise the pleural pressure gradient, the alveolar inflation and the ventilation distribution; 4) to increase lung volume and reduce the amount of atelectatic regions; 5) to facilitate the drainage of secretions; and 6) to reduce ventilator-associated lung injury.According to the available data, the authors conclude that: 1) oxygenation improves iny70-80% of patients with early acute respiratory distress syndrome; 2) the beneficial effects of oxygenation reduce after 1 week of mechanical ventilation; 3) the aetiology of acute respiratory distress syndrome may markedly affect the response to prone positioning; 4) extreme care is necessary when the manoeuvre is performed; 5) pressure sores are frequent and related to the number of pronations; 6) the supports used to prone and during positioning are different and nonstandardised among centres; and 7) intensive care unit and hospital stay and mortality still remain high despite prone positioning. Eur Respir J 2002; 20: 1017-1028. Acute respiratory distress syndrome (ARDS) is characterised by radiographical diffuse bilateral infiltrates, decreased respiratory compliance, small lung volumes and severe hypoxaemia. Correction of lifethreatening hypoxia and improvement of respiratory mechanics and lung volumes are the main treatment goals. To achieve these ends, it is important to select the most appropriate means of ventilatory support, thereby minimising the damaging effects of mechanical ventilation. Currently, ventilatory support using small tidal volumes and low plateau pressures and respiratory rate, to control arterial carbon dioxide tension (Pa,CO 2 ) and pH, are considered optimal [1]. Moreover, the application of relatively high levels of positive end-expiratory pressure (PEEP) seems to be beneficial in reducing ventilator-associated lung injury (VALI) and improving survival [2]. In 1974, BRYAN [3] suggested that anaesthetised and paralysed patients in the prone position should exhibit better expansion of the dorsal lung regions with a consequent improvement in oxygenation. In 1976, PIEHL and BROWN [4] showed, in a retrospective study, that the prone position improved oxygenation in five patients with ARDS without deleterious effects. One year later, DOUGLAS et al. [5] demonstrated, in a prospective study with a limited group of ARDS patients, that prone positioning could effectively improve oxygenation in ARDS. Starting from these repor...

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Section: Ventilator-associated Lung Injury and The Prone Positionsupporting

confidence: 92%

Prone position in acute respiratory distress syndrome

Pelosi¹,

Brazzi²,

Gattinoni³

2002

Eur Respir J

273

167

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“…Positional studies in animal models of lung injury also showed benefits to prone positioning (144,341,530). In dogs undergoing oleic acid injury, more uniform distribution of perfusion was noted in the prone position before injury and redistribution of perfusion away from dependent regions in prone but not supine position following injury (693).…”

Section: Effects Of Posture On Hemodynamicsmentioning

confidence: 96%

Lung Circulation

Suresh

Shimoda

2016

Comprehensive Physiology

111

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The circulation of the lung is unique both in volume and function. For example, it is the only organ with two circulations: the pulmonary circulation, the main function of which is gas exchange, and the bronchial circulation, a systemic vascular supply that provides oxygenated blood to the walls of the conducting airways, pulmonary arteries and veins. The pulmonary circulation accommodates the entire cardiac output, maintaining high blood flow at low intravascular arterial pressure. As compared with the systemic circulation, pulmonary arteries have thinner walls with much less vascular smooth muscle and a relative lack of basal tone. Factors controlling pulmonary blood flow include vascular structure, gravity, mechanical effects of breathing, and the influence of neural and humoral factors. Pulmonary vascular tone is also altered by hypoxia, which causes pulmonary vasoconstriction. If the hypoxic stimulus persists for a prolonged period, contraction is accompanied by remodeling of the vasculature, resulting in pulmonary hypertension. In addition, genetic and environmental factors can also confer susceptibility to development of pulmonary hypertension. Under normal conditions, the endothelium forms a tight barrier, actively regulating interstitial fluid homeostasis. Infection and inflammation compromise normal barrier homeostasis, resulting in increased permeability and edema formation. This article focuses on reviewing the basics of the lung circulation (pulmonary and bronchial), normal development and transition at birth and vasoregulation. Mechanisms contributing to pathological conditions in the pulmonary circulation, in particular when barrier function is disrupted and during development of pulmonary hypertension, will also be discussed.

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“…The effect of body position on oxygenation and pulmonary oxygen uptake has been studied in human medicine with the current evidence suggesting that oxygenation and pulmonary oxygen uptake improve when a patient is moved from dorsal recumbency (supine position) to sternal recumbency (prone position) 1–3 . Experimental studies in sheep, pigs, and dogs have shown a significantly higher PaO 2 when patients are in sternal recumbency as compared with dorsal recumbency 4–14 . A suggested mechanism for this change is a reduction in ventilation:perfusion mismatch and therefore an improvement in pulmonary oxygen uptake 4–14 .…”

Section: Introductionmentioning

confidence: 99%

“…Experimental studies in sheep, pigs, and dogs have shown a significantly higher PaO 2 when patients are in sternal recumbency as compared with dorsal recumbency 4–14 . A suggested mechanism for this change is a reduction in ventilation:perfusion mismatch and therefore an improvement in pulmonary oxygen uptake 4–14 . The relevance of these studies to spontaneously breathing, conscious canine clinical patients is uncertain.…”

Section: Introductionmentioning

confidence: 99%

Effect of body position on the arterial partial pressures of oxygen and carbon dioxide in spontaneously breathing, conscious dogs in an intensive care unit

McMillan

Whitaker

Hughes

et al. 2009

J Vet Emergen Crit Care

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PaO(2) was significantly higher when animals were positioned in sternal recumbency compared with lateral recumbency, predominantly due to improved pulmonary oxygen uptake (decreased A-a difference) rather than increased alveolar ventilation (decreased PaCO(2)). Patients with hypoxemia (defined as PaO(2)<80 mm Hg) in lateral recumbency may benefit from being placed in sternal recumbency. Sternal recumbency is recommended to improve oxygenation in hypoxemic patients.

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Beneficial effects of the prone position on the incidence of barotrauma in oleic acid‐induced lung injury under continuous positive pressure ventilation

Abstract: It was concluded that in lung injury dogs, the prone position has beneficial effects on the incidence of ventilator-induced barotrauma and arterial oxygenation when compared with the lateral position. Ventilator-induced barotrauma may occur at lower airway pressure.

Cited by 15 publications

References 18 publications

Prone position in acute respiratory distress syndrome

Prone position in acute respiratory distress syndrome

Lung Circulation

Effect of body position on the arterial partial pressures of oxygen and carbon dioxide in spontaneously breathing, conscious dogs in an intensive care unit

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