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Published in: Intensive Care Medicine 6/2009

01-06-2009 | Original

Relationship between gas exchange response to prone position and lung recruitability during acute respiratory failure

Published in: Intensive Care Medicine | Issue 6/2009

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Abstract

Purpose

To clarify whether the gas exchange response to prone position is associated with lung recruitability in mechanically ventilated patients with acute respiratory failure.

Methods

In 32 patients, gas exchange response to prone position was investigated as a function of lung recruitability, measured by computed tomography in supine position.

Results

No relationship was found between increased oxygenation in prone position and lung recruitability. In contrast, the decrease of PaCO2 was related with lung recruitability (R 2 0.19; P = 0.01). Patients who decreased their PaCO2 more than the median value (−0.9 mmHg) had a greater lung recruitability (19 ± 16 vs. 8 ± 6%; P = 0.02), higher baseline PaCO2 (48 ± 8 vs. 41 ± 11 mmHg; P = 0.07), heavier lungs (1,968 ± 829 vs. 1,521 ± 342 g; P = 0.06) and more non-aerated tissue (1,009 ± 704 vs. 536 ± 188 g; P = 0.02) than those who did not.

Conclusions

During prone position, changes in PaCO2, but not in oxygenation, are associated with lung recruitability which, in turn, is associated with the severity of lung injury.
Literature
1.
go back to reference Abroug F, Ouanes-Besbes L, Elatrous S, Brochard L (2008) The effect of prone positioning in acute respiratory distress syndrome or acute lung injury: a meta-analysis. Areas of uncertainty and recommendations for research. Intensive Care Med 34:1002–1011PubMedCrossRef Abroug F, Ouanes-Besbes L, Elatrous S, Brochard L (2008) The effect of prone positioning in acute respiratory distress syndrome or acute lung injury: a meta-analysis. Areas of uncertainty and recommendations for research. Intensive Care Med 34:1002–1011PubMedCrossRef
2.
go back to reference Sud S, Sud M, Friedrich JO, Adhikari NK (2008) Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. CMAJ 178:1153–1161PubMed Sud S, Sud M, Friedrich JO, Adhikari NK (2008) Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. CMAJ 178:1153–1161PubMed
3.
go back to reference Broccard A, Shapiro RS, Schmitz LL, Adams AB, Nahum A, Marini JJ (2000) Prone positioning attenuates and redistributes ventilator-induced lung injury in dogs. Crit Care Med 28:295–303PubMedCrossRef Broccard A, Shapiro RS, Schmitz LL, Adams AB, Nahum A, Marini JJ (2000) Prone positioning attenuates and redistributes ventilator-induced lung injury in dogs. Crit Care Med 28:295–303PubMedCrossRef
4.
go back to reference Mentzelopoulos SD, Roussos C, Zakynthinos SG (2005) Prone position reduces lung stress and strain in severe acute respiratory distress syndrome. Eur Respir J 25:534–544PubMedCrossRef Mentzelopoulos SD, Roussos C, Zakynthinos SG (2005) Prone position reduces lung stress and strain in severe acute respiratory distress syndrome. Eur Respir J 25:534–544PubMedCrossRef
5.
go back to reference Nakos G, Batistatou A, Galiatsou E, Konstanti E, Koulouras V, Kanavaros P, Doulis A, Kitsakos A, Karachaliou A, Lekka ME, Bai M (2006) Lung and ‘end organ’ injury due to mechanical ventilation in animals: comparison between the prone and supine positions. Crit Care 10:R38PubMedCrossRef Nakos G, Batistatou A, Galiatsou E, Konstanti E, Koulouras V, Kanavaros P, Doulis A, Kitsakos A, Karachaliou A, Lekka ME, Bai M (2006) Lung and ‘end organ’ injury due to mechanical ventilation in animals: comparison between the prone and supine positions. Crit Care 10:R38PubMedCrossRef
6.
go back to reference Valenza F, Guglielmi M, Maffioletti M, Tedesco C, Maccagni P, Fossali T, Aletti G, Porro GA, Irace M, Carlesso E, Carboni N, Lazzerini M, Gattinoni L (2005) Prone position delays the progression of ventilator-induced lung injury in rats: does lung strain distribution play a role? Crit Care Med 33:361–367PubMedCrossRef Valenza F, Guglielmi M, Maffioletti M, Tedesco C, Maccagni P, Fossali T, Aletti G, Porro GA, Irace M, Carlesso E, Carboni N, Lazzerini M, Gattinoni L (2005) Prone position delays the progression of ventilator-induced lung injury in rats: does lung strain distribution play a role? Crit Care Med 33:361–367PubMedCrossRef
7.
go back to reference Gattinoni L, Pelosi P, Vitale G, Pesenti A, D’Andrea L, Mascheroni D (1991) Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure. Anesthesiology 74:15–23PubMedCrossRef Gattinoni L, Pelosi P, Vitale G, Pesenti A, D’Andrea L, Mascheroni D (1991) Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure. Anesthesiology 74:15–23PubMedCrossRef
8.
go back to reference Gattinoni L, Carlesso E, Cadringher P, Valenza F, Vagginelli F, Chiumello D (2003) Physical and biological triggers of ventilator-induced lung injury and its prevention. Eur Respir J Suppl 47:15s–25sPubMedCrossRef Gattinoni L, Carlesso E, Cadringher P, Valenza F, Vagginelli F, Chiumello D (2003) Physical and biological triggers of ventilator-induced lung injury and its prevention. Eur Respir J Suppl 47:15s–25sPubMedCrossRef
9.
go back to reference Haitsma JJ, Lachmann B (2006) Lung protective ventilation in ARDS: the open lung maneuver. Minerva Anestesiol 72:117–132PubMed Haitsma JJ, Lachmann B (2006) Lung protective ventilation in ARDS: the open lung maneuver. Minerva Anestesiol 72:117–132PubMed
10.
go back to reference Tremblay LN, Slutsky AS (2006) Ventilator-induced lung injury: from the bench to the bedside. Intensive Care Med 32:24–33PubMedCrossRef Tremblay LN, Slutsky AS (2006) Ventilator-induced lung injury: from the bench to the bedside. Intensive Care Med 32:24–33PubMedCrossRef
11.
go back to reference Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di Giulio P, Fumagalli R, Pelosi P, Brazzi L, Latini R, Prone-Supine Study Group (2001) Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 345:568–573PubMedCrossRef Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di Giulio P, Fumagalli R, Pelosi P, Brazzi L, Latini R, Prone-Supine Study Group (2001) Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 345:568–573PubMedCrossRef
12.
go back to reference Guerin C, Gaillard S, Lemasson S, Ayzac L, Girard R, Beuret P, Palmier B, Le QV, Sirodot M, Rosselli S, Cadiergue V, Sainty JM, Barbe P, Combourieu E, Debatty D, Rouffineau J, Ezingeard E, Millet O, Guelon D, Rodriguez L, Martin O, Renault A, Sibille JP, Kaidomar M (2004) Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA 292:2379–2387PubMedCrossRef Guerin C, Gaillard S, Lemasson S, Ayzac L, Girard R, Beuret P, Palmier B, Le QV, Sirodot M, Rosselli S, Cadiergue V, Sainty JM, Barbe P, Combourieu E, Debatty D, Rouffineau J, Ezingeard E, Millet O, Guelon D, Rodriguez L, Martin O, Renault A, Sibille JP, Kaidomar M (2004) Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA 292:2379–2387PubMedCrossRef
13.
go back to reference Mancebo J, Fernandez R, Blanch L, Rialp G, Gordo F, Ferrer M, Rodríguez F, Garro P, Ricart P, Vallverdú I, Gich I, Castaño J, Saura P, Domínguez G, Bonet A, Albert RK (2006) A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med 173:1233–1239PubMedCrossRef Mancebo J, Fernandez R, Blanch L, Rialp G, Gordo F, Ferrer M, Rodríguez F, Garro P, Ricart P, Vallverdú I, Gich I, Castaño J, Saura P, Domínguez G, Bonet A, Albert RK (2006) A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med 173:1233–1239PubMedCrossRef
14.
go back to reference Fernandez R, Trenchs X, Klamburg J, Castedo J, Serrano JM, Besso G, Tirapu JP, Santos A, Mas A, Parraga M, Jubert P, Frutos F, Añon JM, Garcia M, Rodriguez F, Yebenes JC, Lopez MJ (2008) Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial. Intensive Care Med 34:1487–1491PubMedCrossRef Fernandez R, Trenchs X, Klamburg J, Castedo J, Serrano JM, Besso G, Tirapu JP, Santos A, Mas A, Parraga M, Jubert P, Frutos F, Añon JM, Garcia M, Rodriguez F, Yebenes JC, Lopez MJ (2008) Prone positioning in acute respiratory distress syndrome: a multicenter randomized clinical trial. Intensive Care Med 34:1487–1491PubMedCrossRef
15.
go back to reference Gattinoni L, Vagginelli F, Carlesso E, Taccone P, Conte V, Chiumello D, Valenza F, Caironi P, Pesenti A, Prone-Supine Study Group (2003) Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med 31:2727–2733PubMedCrossRef Gattinoni L, Vagginelli F, Carlesso E, Taccone P, Conte V, Chiumello D, Valenza F, Caironi P, Pesenti A, Prone-Supine Study Group (2003) Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med 31:2727–2733PubMedCrossRef
16.
go back to reference Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G (2006) Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 354:1775–1786PubMedCrossRef Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G (2006) Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 354:1775–1786PubMedCrossRef
17.
go back to reference Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R (1994) Report of the American–European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination The Consensus Committee. Intensive Care Med 20:225–232PubMedCrossRef Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R (1994) Report of the American–European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination The Consensus Committee. Intensive Care Med 20:225–232PubMedCrossRef
18.
go back to reference Gattinoni L, Caironi P, Pelosi P, Goodman LR (2001) What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 164:1701–1711PubMed Gattinoni L, Caironi P, Pelosi P, Goodman LR (2001) What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 164:1701–1711PubMed
19.
go back to reference Dantzker DR, Lynch JP, Weg JG (1980) Depression of cardiac output is a mechanism of shunt reduction in the therapy of acute respiratory failure. Chest 77:636–642PubMedCrossRef Dantzker DR, Lynch JP, Weg JG (1980) Depression of cardiac output is a mechanism of shunt reduction in the therapy of acute respiratory failure. Chest 77:636–642PubMedCrossRef
20.
go back to reference Hopkins SR, Johnson EC, Richardson RS, Wagner H, De Rosa M, Wagner PD (1997) Effects of inhaled nitric oxide on gas exchange in lungs with shunt or poorly ventilated areas. Am J Respir Crit Care Med 156:484–491PubMed Hopkins SR, Johnson EC, Richardson RS, Wagner H, De Rosa M, Wagner PD (1997) Effects of inhaled nitric oxide on gas exchange in lungs with shunt or poorly ventilated areas. Am J Respir Crit Care Med 156:484–491PubMed
21.
go back to reference Papazian L, Paladini MH, Bregeon F, Thirion X, Durieux O, Gainnier M, Huiart L, Agostini S, Auffray JP (2002) Can the tomographic aspect characteristics of patients presenting with acute respiratory distress syndrome predict improvement in oxygenation-related response to the prone position? Anesthesiology 97:599–607PubMedCrossRef Papazian L, Paladini MH, Bregeon F, Thirion X, Durieux O, Gainnier M, Huiart L, Agostini S, Auffray JP (2002) Can the tomographic aspect characteristics of patients presenting with acute respiratory distress syndrome predict improvement in oxygenation-related response to the prone position? Anesthesiology 97:599–607PubMedCrossRef
22.
go back to reference Galiatsou E, Kostanti E, Svarna E, Kitsakos A, Koulouras V, Efremidis SC, Nakos G (2006) Prone position augments recruitment and prevents alveolar overinflation in acute lung injury. Am J Respir Crit Care Med 174:187–197PubMedCrossRef Galiatsou E, Kostanti E, Svarna E, Kitsakos A, Koulouras V, Efremidis SC, Nakos G (2006) Prone position augments recruitment and prevents alveolar overinflation in acute lung injury. Am J Respir Crit Care Med 174:187–197PubMedCrossRef
23.
go back to reference Pelosi P, D’Andrea L, Vitale G, Pesenti A, Gattinoni L (1994) Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med 149:8–13PubMed Pelosi P, D’Andrea L, Vitale G, Pesenti A, Gattinoni L (1994) Vertical gradient of regional lung inflation in adult respiratory distress syndrome. Am J Respir Crit Care Med 149:8–13PubMed
24.
go back to reference Gattinoni L, D’Andrea L, Pelosi P, Vitale G, Pesenti A, Fumagalli R (1993) Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA 269:2122–2127PubMedCrossRef Gattinoni L, D’Andrea L, Pelosi P, Vitale G, Pesenti A, Fumagalli R (1993) Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA 269:2122–2127PubMedCrossRef
25.
go back to reference Gattinoni L, Protti A (2008) Ventilation in the prone position: for some but not for all? CMAJ 178:1174–1176PubMed Gattinoni L, Protti A (2008) Ventilation in the prone position: for some but not for all? CMAJ 178:1174–1176PubMed
26.
go back to reference Marini JJ, Gattinoni L (2008) Propagation prevention: a complementary mechanism for “lung protective” ventilation in acute respiratory distress syndrome. Crit Care Med 36:3252–3258PubMedCrossRef Marini JJ, Gattinoni L (2008) Propagation prevention: a complementary mechanism for “lung protective” ventilation in acute respiratory distress syndrome. Crit Care Med 36:3252–3258PubMedCrossRef
Metadata
Title
Relationship between gas exchange response to prone position and lung recruitability during acute respiratory failure
Publication date
01-06-2009
Published in
Intensive Care Medicine / Issue 6/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1411-x

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