Effect of Prone and Supine Positions on Functional  Residual Capacity, Oxygenation, and Respiratory  Mechanics in Ventilated Infants and Children

Numa, Andrew; Hammer, Jürg; Newth, Christopher J. L.

doi:10.1164/ajrccm.156.4.9601042

Cited by 76 publications

(53 citation statements)

References 23 publications

(39 reference statements)

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“…and children (26) that showed a significant increase of Pa O 2 (in Sighs. We chose to use sighs as a RM because they maintain our case an average of 60 mm Hg) associated with a modest recruitment for a period of at least one hour without hemodyincrease of EELV (approximately 200 ml; Table 3).…”

Section: Methodological Considerationsmentioning

confidence: 94%

Sigh in Supine and Prone Position during Acute Respiratory Distress Syndrome

Pelosi¹,

Bottino²,

Chiumello³

et al. 2003

Am J Respir Crit Care Med

120

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A way to achieve a more even distribution of lung inflation (13-15).Hence, we designed this study of patients with early ARDS Keywords: acute lung injury; acute respiratory distress syndrome; meto test the hypothesis that prone position enhances the physichanical ventilation; recruitment; end-expiratory lung volume ologic effect of a RM. Our hypothesis is supported by the findings of a canine model of ALI showing that a lower PEEP Mechanical ventilation with low tidal volume may prevent is required in the prone than in the supine position to preserve ventilator-induced lung injury (VILI) and increased survival the effects of a RM (16). Our hypothesis is clinically relevant of patients with acute lung injury/acute respiratory distress because approximately 50% of ARDS patients do not exhibit syndrome (ALI/ARDS) (1). However, using low ventilatory a satisfactory response to a RM in the supine position (6, 7). volumes may also limit alveolar inflation and promote atelectasis and hypoxemia (2, 3). Thus, "lung protective" strategies METHODS to ventilate patients with ALI/ARDS have to consider two potentially conflicting goals: preventing VILI and reinflating Study Population collapsed alveoli. Servo ventilator 300 C (Siemens, Solna, Sweden). All had indwelling of RMs include the following: (1 ) the concomitant use of arterial and pulmonary artery catheters. The study included the following periods: baseline supine (2 hours), sighs in supine (1 hour), second baseline supine (1 hour), baseline prone (2 hours), sigh in prone (1 hour), and second baseline prone (1 hour). Measurements were taken at the end of each period, and the entire study lasted approximately 8 (Received in original form March 13, 2002; accepted in final form November 27, 2002) hours. Patients were positioned prone as previously described (14).Correspondence and requests for reprints should be addressed to Luciano GattiMechanical ventilation was provided using a tidal volume of approxinoni, Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, mately 7 ml/kg of actual body weight to maintain an upper limit of This article has an online supplement, which is accessible from this issue's table because it was associated with a decreased compliance of the chest wall of contents online at www.atsjournals.org and was not deemed to reflect an increase in transpulmonary pressure.

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Section: Methodological Considerationsmentioning

confidence: 94%

Sigh in Supine and Prone Position during Acute Respiratory Distress Syndrome

Pelosi¹,

Bottino²,

Chiumello³

et al. 2003

Am J Respir Crit Care Med

120

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“…A recent study showed the prone position to be safe and to provide a beneficial response in paediatric patients with respiratory failure [48]. However, a second study reported an increase in oxygenation following prone positioning only in a subgroup of patients with obstructive lung disease [49]. In patients aged 1-5 yrs, with respiratory failure after liver transplantation, the authors observed an improvement in respiratory function following prone positioning, and this manoeuvre is used by the authors in clinical practice when indicated.…”

Section: Paediatric Patientsmentioning

confidence: 99%

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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“…There are several studies on oxygen saturation and oxygen partial pressure in adults and children that show that both of them improve in the prone position compared to supine, and this improvement is more evident in the presence of lung pathology [7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Response of oxygen saturation in preterm infants receiving rib cage stabilization with an elastic band in two body positions: a randomized clinical trial

Brunherotti¹,

Martinez²

2013

Braz. J. Phys. Ther.

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| Background: Preterm newborns have higher thoracic compliance, providing less stability to the different forces of distortion imposed on the rib cage, leading to instability of the chest. Adequate body position may reduce this instability and facilitate respiratory work. Objective: To assess the oxygen saturation response of preterm newborns receiving rib cage stabilization with an elastic band in two body positions. Method: A clinical, prospective, randomized crossover study was conducted, including sixteen newborns with a gestational age of 31 to 35 weeks (mean 32.8 weeks) at a tertiary care facility, who did not receive supplemental oxygen. The infants were placed in a sequence of prone and supine positions with and without chest stabilization with an elastic band. Respiratory rate, heart rate, and oxygen saturation were measured at 10-minute intervals, corresponding to 7 samplings of 60 minutes. Data collection was interrupted when oxygen saturation was less than 90%. Results: The mean gestational age of the infants was 32.8±1.5 weeks and the mean birth weight was 1,789±255g. Better values for the variables studied were observed in the supine position with an elastic chest band compared to the supine position without the band. The positions using an elastic band resulted in lower mean respiratory rate and heart rate and higher oxygen saturation. Conclusion: The use of an elastic chest band improves respiratory indicators such as oxygen saturation.Keywords: respiratory mechanics; preterm newborn; supine position; prone position; movement. Article registered in Registro Brasileiro de Ensaios Clinicos (ReBEC) under number RBR-7wm8mz. HOW TO CITE THIS ARTICLEBrunherotti MAA, Martinez FE. Response of oxygen saturation in preterm infants receiving rib cage stabilization with an elastic band in two body positions: a randomized clinical trial. Braz J Phys Ther.

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Effect of Prone and Supine Positions on Functional Residual Capacity, Oxygenation, and Respiratory Mechanics in Ventilated Infants and Children

Cited by 76 publications

References 23 publications

Sigh in Supine and Prone Position during Acute Respiratory Distress Syndrome

Sigh in Supine and Prone Position during Acute Respiratory Distress Syndrome

Prone position in acute respiratory distress syndrome

Response of oxygen saturation in preterm infants receiving rib cage stabilization with an elastic band in two body positions: a randomized clinical trial

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