Prone Position Augments Recruitment and Prevents Alveolar Overinflation in Acute Lung Injury

Galiatsou, Eftichia; Kostanti, Eleonora; Svarna, Eugenia; Kitsakos, Athanasios; Koulouras, Vasilios; Efremidis, Stauros C.; Νάκος, Γεώργιος

doi:10.1164/rccm.200506-899oc

Cited by 223 publications

(169 citation statements)

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“…In the lobar as opposed to diffuse ARDS, prone position reduces more non-aerated lung and overinflated areas. Patients with diffuse ARDS showed no reversal of ventral overinflation [100] The effect of PEEP is a function of the recruitable lung. Patients with P/F < 300 (19 patients with 200 < P/F < 300: mild ARDS; 49 patients with P/F < 200: moderate ARDS), after 5−6 days of mechanical ventilation, present highly variable recruitable lung.…”

Section: A Peep Peep [4[ (mentioning

confidence: 86%

“…The shunt increases as gravity directs the flow to poorly aerated/ /atelectatic regions. When supine, the PEEP accentuates the gravity dependence of the blood flow [100] and worsens the VA/Q ratio. Under CMV in the supine position, the Vt preferentially distributes itself anteriorly (i.e., ventrally) [97,101] towards non-dependent and less perfused areas.…”

Section: ) or < 26 CM H 2 O [41] When The Rv Is Considered ( § I A 2)mentioning

confidence: 99%

“…6 in [81]) [78,81]; b) promotes the recruitment of juxta-diaphragmatic lung regions by decreasing chest wall compliance through a limitation of the expansion of the cephalad thorax and reduced overdistension in "focal" ARDS; in contrast, proning in diffuse ARDS does not result in the reversal of ventral hyperinflation [100]; c) reduces the shunt as the ventilation increases in wellperfused areas [102]; d) may improve lymphatic drainage as the heart moves ventrally, lowering hydrostatic edema [5]; e) reduces the interfaces between closed and open units ("stress focusing junctions"), thus inflammation. Thus, early prolonged proning reduces mortality to low levels (prone, 16%; supine, 33%) in patients with severe ARDS (P/F < 150; 4 sessions of 17 h) [27].…”

Section: ) or < 26 CM H 2 O [41] When The Rv Is Considered ( § I A 2)mentioning

confidence: 99%

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Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Petitjeans

Pichot²,

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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Severe acute respiratory distress syndrome (ARDS, PaO 2 /FiO 2 < 100 on PEEP ≥ 5 cm H 2 O) is treated using controlled mechanical ventilation (CMV), recently combined with muscle relaxation for 48 h and prone positioning. While the amplitude of tidal volume appears set £ 6 mL kg -1 , the level of positive end-expiratory pressure (PEEP) remains controversial. This overview summarizes several salient points, namely: a) ARDS is an oxygenation defect: consolidation/difuse alveolar damage is reversed by PEEP and/or prone positioning, at least during the early phase of ARDS b) ARDS is a dynamic disease and partially iatrogenic. This implies that the management of the ventilator may be a life-saver by reducing the duration of mechanical ventilation, or detrimental by extending this duration, leading into critical care-acquired diseases. Indeed, a high PEEP (10−24 cm H 2 O) appears to be a life-saver in the context of early severe diffuse ARDS; c) tidal volume and plateau pressure cannot be identical for all patients; d) the only remaining rationale for CMV and muscle relaxation is to suppress patient-ventilator asynchrony and to lower VO 2 , during the acute cardio-ventilatory distress. Therefore, in early severe diffuse ARDS, this review argues for a combination of a high PEEP (preferably titrated on transpulmonary pressure) with spontaneous ventilation + pressure support (or newer modes of ventilation). However, conditionalities are stringent: upfront circulatory optimization, upright positioning, lowered VO 2 , lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone. As these propositions require evidence-based demonstration, the accepted practice remains, in 2016, controlled mechanical ventilation, muscle relaxation, and prone position.

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Section: A Peep Peep [4[ (mentioning

confidence: 86%

Section: ) or < 26 CM H 2 O [41] When The Rv Is Considered ( § I A 2)mentioning

confidence: 99%

Section: ) or < 26 CM H 2 O [41] When The Rv Is Considered ( § I A 2)mentioning

confidence: 99%

See 1 more Smart Citation

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Petitjeans

Pichot²,

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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“…Galiatsou et al (31) performed a study evaluating and quantifying with CT the regional lung volume changes when diffuse or lobar ALI patients were turned into prone position after ARM. For both maneuvers (alveolar recruitment and prone position) they found increased oxygenation in lobar ALI patients.…”

Section: Prone Positionmentioning

confidence: 99%

Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo

Costa¹,

Rocha²,

Ribeiro³

2009

Rev. bras. ter. intensiva

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“…Isto posto, nos parece que o fator contribuinte principal para a ocorrên-cia de hipoxemia no grupo de animais submetidos a sutura manual do coto brônquico, tenha sido de fato a ocorrência de atelectasia por maior manipulação do pulmão. Durante a anestesia, procurou-se empregar uma FIO 2 de 80% pois quando se emprega 100% de oxigênio, a chance de atelectasia pós-operatória é muito maior (Galiatsou et al 2006). Durante a avaliação de todos os momentos pós-operató-rios, foi mantido o equilíbrio ácido-básico, vale dizer que nenhum animal dos Grupos A e B desenvolveu alcalose ou acidose após a exérese do pulmão esquerdo, à semelhança ao observado por Wilcox et al (1979), Hsia et al (1990), Hjaimarsen et al (1995) e Miyazawa et al (1999) em seus estudos.…”

Section: Discus Discus Discus Discus Discussão São São São Sãounclassified

Avaliação hemogasométrica em cães submetidos à pneumonectomia esquerda

Binoki¹,

Jatene

Fantoni³

et al. 2007

Pesq. Vet. Bras.

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Moléstias de natureza infecciosa, traumática ou neoplásica acometem o pulmão dos cães, constituindo-se a pneumonectomia como possibilidade de tratamento para algumas dessas afecções. Assim, diante da escassez de dados encontrados na literatura, objetivou-se avaliar e comparar parâmetros hemogasométricos, pressão parcial de oxigênio (PaO2), de dióxido de carbono (PaCO2), concentração do íon hidrogênio (pH) e do íon bicarbonato [HCO3-] no sangue arterial de cães adultos, antes e após pneumonectomia esquerda. Foram estudados 18 cães, machos e fêmeas de idades variadas, pesando entre 15 e 20 kg, distribuídos aleatoriamente em dois grupos de 9 animais cada. No Grupo A, o coto brôn-quico esquerdo dos cães foi suturado manualmente com fio de polipropileno 5-0, e no Grupo B, o coto brônquico esquerdo foi suturado mecanicamente com grampeador cirúrgico. Os dados foram colhidos em 6 momentos: antes da administração da medicação pré-anestésica (T0), 1 hora após a extubação do animal (T1EXT), 48 horas após a intervenção cirúrgica (T48h), 17 (T7d), 15 (T15d) e 36 dias (T36d) após intervenção cirúrgica. Em seguida, foi realizada a análise estatística (teste de normalidade de Anderson-Darling, Wilcox e teste U de Man-Whitney). Os valores de PaO2 do Grupo A no T1EXT (67,00±11,31) mostraram-se significativamente inferiores em relação ao T0 (99,44±18,34), fato este que não ocorreu no Grupo B: T1EXT (87,00±8,35) em relação ao T0 (87,00±7,55). Não houve diferença do pH entre os momentos nos cães do grupo A, porém no grupo B observou-se uma diminuição em T1EXT (7,3644±0,0353) em relação ao T0 (7,4189±0,0136), sem que os animais tenham desenvolvido acidose. Apesar dessas alterações, concluiu-se que os cães submetidos à pneumonectomia esquerda (sutura manual ou mecânica do coto brônquico esquerdo) não apresentaram tendência a desenvolver desequilíbrio ácido-básico no período em que foram avaliados.

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Prone Position Augments Recruitment and Prevents Alveolar Overinflation in Acute Lung Injury

Abstract: Prone position recruited the edematous lung further than recruitment maneuvers and reversed overinflation, resulting in a more homogeneous distribution of aeration. The effects of the prone position were more pronounced in patients with lobar ALI.

Cited by 223 publications

References 38 publications

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Associação das manobras de recrutamento alveolar e posição prona na síndrome do desconforto respiratório agudo

Avaliação hemogasométrica em cães submetidos à pneumonectomia esquerda

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