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01-02-2005 | Original

Prone position improves mechanics and alveolar ventilation in acute respiratory distress syndrome

Authors: Antoine Vieillard-Baron, Anne Rabiller, Karin Chergui, Olivier Peyrouset, Bernard Page, Alain Beauchet, François Jardin

Published in: Intensive Care Medicine | Issue 2/2005

Abstract

Objective

We tested the hypothesis that ventilation in the prone position might improve homogenization of tidal ventilation by reducing time-constant inequalities, and thus improving alveolar ventilation. We have recently reported in ARDS patients that these inequalities are responsible for the presence of a “slow compartment,” excluded from tidal ventilation at supportive respiratory rate.

Design

In 11 ARDS patients treated by ventilation in the prone position because of a major oxygenation impairment (PaO₂/FIO₂≤100 mm Hg) we studied mechanical and blood gas changes produced by a low PEEP (6±1 cm H₂O), ventilation in the prone position, and the two combined.

Results

Ventilation in the prone position significantly reduced the expiratory time constant from 1.98±0.53 s at baseline with ZEEP to 1.53±0.34 s, and significantly decreased PaCO₂ from 55±11 mm Hg at baseline with ZEEP to 50±7 mm Hg. This improvement in alveolar ventilation was accompanied by a significant improvement in respiratory system mechanics, and in arterial oxygenation, the latter being markedly increased by application of a low PEEP (PaO₂/FIO₂ increasing from 64±19 mm Hg in supine position with ZEEP to 137±88 mm Hg in prone with a low PEEP).

Conclusion

In severely hypoxemic patients, prone position was able to improve alveolar ventilation significantly by reducing the expiratory time constant.

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Title: Prone position improves mechanics and alveolar ventilation in acute respiratory distress syndrome
Authors: Antoine Vieillard-Baron
Anne Rabiller
Karin Chergui
Olivier Peyrouset
Bernard Page
Alain Beauchet
François Jardin
Publication date: 01-02-2005
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-004-2478-z

At a glance: The STEP trials

Springer Medicine

Prone position improves mechanics and alveolar ventilation in acute respiratory distress syndrome

Abstract

Objective

Design

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design

Results

Conclusion

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