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What is the optimal duration of ventilation in the prone position in acute lung injury and acute respiratory distress syndrome?
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McAuley, D., Giles, S., Fichter, H., Perkins, Gavin D. and Gao, F. (2002) What is the optimal duration of ventilation in the prone position in acute lung injury and acute respiratory distress syndrome? Intensive Care Medicine, 28 (4). pp. 414-418. doi:10.1007/s00134-002-1248-z
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Official URL: http://dx.doi.org/10.1007/s00134-002-1248-z
Abstract
Objective: To evaluate the effects of prone ventilation on respiratory parameters and extravascular lung water (EVLW) in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in order to characterise the optimal duration of ventilation in the prone position. Design: Prospective, observational study. Setting: Nine-bed general intensive care unit. Patients: Eleven patients with refractory hypoxaemia due to ALI/ARDS were prospectively investigated during 12 consecutive episodes of prone ventilation. Interventions: Ventilation in the prone position for 18 h. Measurements and main results: Measurements were obtained supine and after 1, 2, 6, 12 and 18 h in the prone position and 1 h after returning supine. There was a progressive improvement in PaO2/fraction of inspired oxygen (FIO2) ratio which reached significance after 12 h [121 (81-151) to 258 (187-329) torr; p<0.05]. EVLW index increased transiently at 1 h [14.2 (7.6-20.8) to 15.1 (9.0-20.2); p=0.05] and thereafter declined progressively and was significantly decreased at 18 h [12.1 (7.2-17.0); p=0.043]. The shunt fraction showed an early fall [0.41 (0.40-0.42) to 0.31 (0.30-0.32) at 1 h;p<0.001] preceding a subsequent progressive fall [0.22 (0.21-0.23) at 18 h;p<0.001]. Conclusions: Over the 18h period studied there was progressive improvement in gas exchange, pulmonary shunt and EVLW. Although it is not possible to exclude that improvement over this period was unrelated to prone positioning, these findings suggests that ventilation in the prone position for more prolonged periods may be required for optimal improvement and warrants further study.
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > R Medicine (General) | ||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Journal or Publication Title: | Intensive Care Medicine | ||||||
| Publisher: | Springer-Verlag | ||||||
| ISSN: | 0342-4642 | ||||||
| Official Date: | April 2002 | ||||||
| Dates: |
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| Volume: | 28 | ||||||
| Number: | 4 | ||||||
| Page Range: | pp. 414-418 | ||||||
| DOI: | 10.1007/s00134-002-1248-z | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access |
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