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01-02-2019 | Letter

Effect of body position and inclination in supine and prone position on respiratory mechanics in acute respiratory distress syndrome

Authors: Mehdi Mezidi, Claude Guérin

Published in: Intensive Care Medicine | Issue 2/2019

Excerpt

The mechanism by which prone position (PP) reduces mortality in moderate-to-severe acute respiratory distress syndrome (ARDS) patients as compared to supine (SP) [1] likely includes reduction/homogenization of lung stress/strain. The common accepted scenario is that this effect stems from an increase in chest wall elastance (Est,cw) in PP. However, whether, and to what extent, the angulation of the body may affect Est,cw is unclear. Our hypothesis is that thorax inclination significantly changes respiratory system mechanics and lung volume from SP to PP, as previously suggested in healthy humans [2] and anesthetized patients [3]. …

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Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L, PROSEVA Study Group (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368:2159–2168CrossRefPubMed

Washko GR, O'Donnell CR, Loring SH (2006) Volume-related and volume-independent effects of posture on esophageal and transpulmonary pressures in healthy subjects. J Appl Physiol (1985) 100:753–758CrossRef

Kumaresan A, Gerber R, Mueller A, Loring SH, Talmor D (2018) Effects of prone positioning on transpulmonary pressures and end-expiratory volumes in patients without lung disease. Anesthesiology 128:1187–1192CrossRefPubMed

Mezidi M, Parrilla FJ, Yonis H, Riad Z, Bohm SH, Waldmann AD, Richard JC, Lissonde F, Tapponnier R, Baboi L, Mancebo J, Guerin C (2018) Effects of positive end-expiratory pressure strategy in supine and prone position on lung and chest wall mechanics in acute respiratory distress syndrome. Ann Intensive Care 8:86CrossRefPubMedPubMedCentral

Riad Z, Mezidi M, Subtil F, Louis B, Guerin C (2018) Short-term effects of the prone positioning maneuver on lung and chest wall mechanics in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 197:1355–1358CrossRefPubMed

Title: Effect of body position and inclination in supine and prone position on respiratory mechanics in acute respiratory distress syndrome
Authors: Mehdi Mezidi
Claude Guérin
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 2/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5493-1

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Effect of body position and inclination in supine and prone position on respiratory mechanics in acute respiratory distress syndrome

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