Published in:
01-12-2003 | Brief Report
Prone ventilation following witnessed pulmonary aspiration: the effect on oxygenation
Published in: Intensive Care Medicine | Issue 12/2003
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Objective
Pulmonary aspiration is a significant cause of admission to the ITU and is associated with significant morbidity and mortality. Aspiration in the supine position produces posterior collapse/consolidation, similar to that seen in ALI/ARDS patients. Prone positioning has been shown to improve oxygenation in ALI/ARDS, but no studies have been performed on pulmonary aspiration.
Design
A prospective crossover study.
Setting
Twelve-bed ITU.
Patients and participants
Eleven patients admitted to ITU with respiratory failure secondary to witnessed pulmonary aspiration requiring ventilation and an FIO2 >0.50 after 12 h.
Interventions
Patients were placed in a prone position for 8 h and then turned supine for 8 h. Prone positioning was repeated if the FIO2 remained >0.50. Ventilator settings were not altered in the study period.
Measurements and results
Arterial blood gas analysis was performed every 2 h. The PaO2/FIO2 gradient was calculated. Oxygenation improved on turning prone, with a significant increase in the PaO2/FIO2 ratio (P<0.01). There was a fall in this gradient on return to the supine position. There was a significant improvement in oxygenation on turning prone for the second period (P<0.01). Overall, there was a significant improvement in the PaO2/FIO2 ratio in the final supine position when compared to the first (P<0.05).
Conclusion
This study demonstrates a significant improvement in oxygenation in the prone position in pulmonary aspiration. Early prone positioning in patients with pulmonary aspiration requiring ventilation may improve oxygenation by altering V/Q relationships similarly to ARDS, but also may aid drainage of secretions, opening up alveoli and preventing progression to established pneumonitis.