Prone position prevents regional alveolar hyperinflation and mechanical stress and strain in mild experimental acute lung injury

Santana, Maria Cristina E.; Garcia, Cristiane Sousa Nascimento Baez; Xisto, Débora G.; Nagato, Lilian K.S.; Lassance, Roberta M.; Prota, Luiz Felipe M.; Ornellas, Felipe M.; Capelozzi, Vera Luíza; Morales, Marcelo M.; Zin, Walter A.; Pelosi, Paolo; Rocco, Patrícia Rieken Macêdo

doi:10.1016/j.resp.2009.04.006

Cited by 31 publications

(13 citation statements)

References 39 publications

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“…43,48 Intriguingly, pharmacologically inhibiting these same pathways protects experimental animals from lung injury, thus identifying molecular mechanisms underlying VILI. 43 In humans, histological data are unavailable, but both serum and bronchoalveolar lavage inflammatory markers are reduced by prone positioning, which may reflect less VILI.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Treatment of ARDS With Prone Positioning

Scholten

Beitler

Prisk

et al. 2017

Chest

308

277

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Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Treatment of ARDS With Prone Positioning

Scholten

Beitler

Prisk

et al. 2017

Chest

308

277

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“…151 Several experimental models of ARDS, both with and without VILI, have examined whether PP confers a lungprotective benefit compared with SP. [152][153][154][155][156] Broccard et al 152 combined oleic acid with high-stretch injury, producing similar degrees of pulmonary edema formation throughout the lung regardless of position. However, histologic injury was less severe and less extensive in dependent lung regions with PP.…”

Section: Effects Of Pp On Vili In Experimental and Clinical Ardsmentioning

confidence: 99%

“…The lungs appeared slightly shorter and wider with a corresponding 28% reduction in estimated lung strain, consistent with more homogeneous pleural pressure distribution in PP. 154 Santana et al 156 found that PP resulted in decreased lung elastance and viscoelastance associated with a more homogeneous distribution of alveolar air/tissue ratios.…”

Section: Effects Of Pp On Vili In Experimental and Clinical Ardsmentioning

confidence: 99%

A Comprehensive Review of Prone Position in ARDS

2015

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Prone position (PP) has been used since the 1970s to treat severe hypoxemia in patients with ARDS because of its effectiveness at improving gas exchange. Compared with the supine position (SP), placing patients in PP effects a more even tidal volume distribution, in part, by reversing the vertical pleural pressure gradient, which becomes more negative in the dorsal regions. PP also improves resting lung volume in the dorsocaudal regions by reducing the superimposed pressure of both the heart and the abdomen. In contrast, pulmonary perfusion remains preferentially distributed to the dorsal lung regions, thus improving overall alveolar ventilation/perfusion relationships. 1660RESPIRATORY CARE • NOVEMBER 2015 VOL 60 NO 11Moreover, the larger tissue mass suspended from a wider dorsal chest wall effects a more homogeneous distribution of pleural pressures throughout the lung that reduces abnormal strain and stress development. This is believed to ameliorate the severity or development of ventilator-induced lung injury and may partly explain why PP reduces mortality in severe ARDS. Over 40 years of clinical trials have consistently reported improved oxygenation in approximately 70% of subjects with ARDS. Early initiation of PP is more likely to improve oxygenation than initiation during the subacute phase. Maximal oxygenation improvement occurs over a wide time frame ranging from several hours to several days. Meta-analyses of randomized controlled trials suggest that PP provides a survival advantage only in patients with relatively severe ARDS (P aO 2 /F IO 2 <150 mm Hg). Moreover, survival is enhanced when patients are managed with a smaller tidal volume (<8 mL/kg), higher PEEP (10 -13 cm H 2 O), and longer duration of PP sessions (>10 -12 h/session). Combining adjunctive therapies (high PEEP, recruitment maneuvers, and inhaled vasodilators) with PP has an additive effect in improving oxygenation and may be particularly helpful in stabilizing gas exchange in very severe ARDS.

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“…The findings of Caironi et al go toward this direction. Moreover, there is increasing evidence that all the maneuvers aimed at decreasing lung inhomogeneity, when it is severe, such as higher PEEP [37][38][39] and prone position [13,40,41], tend to improve outcome, as shown in recent meta-analyses [42,43].…”

Section: End-inspiratory Lung Stress and Strain And Stress Raisers Inmentioning

confidence: 99%