Prone position improves lung mechanical behavior and enhances gas exchange efficiency in mechanically ventilated chronic obstructive pulmonary disease patients.

Anesthesia and Analgesia
S D MentzelopoulosArgyris S Michalopoulos

Abstract

Pronation might favorably affect respiratory system (rs) mechanics and function in volume-controlled, mode-ventilated chronic obstructive pulmonary disease (COPD) patients. We studied 10 COPD patients, initially positioned supine (baseline supine [supine(BAS)]) and then randomly and consecutively changed to protocol supine (supine(PROT)), semirecumbent, and prone positions. Rs mechanics and inspiratory work (W(I)) were assessed at baseline (0.6 L) (all postures) and sigh (1.2 L) (supine(BAS) excluded) tidal volume (V(T)) with rapid airway occlusion during constant-flow inflation. Hemodynamics and gas exchange were assessed in all postures. There were no complications. Prone positioning resulted in (a) increased dynamic-static chest wall (cw) elastance (at both V(Ts)) and improved oxygenation versus supine(BAS), supine(PROT), and semirecumbent, (b) decreased additional lung (L) resistance-elastance versus supine(PROT) and semirecumbent at sigh V(T), (c) decreased L-static elastance (at both V(Ts)) and improved CO(2) elimination versus supine(BAS) and supine(PROT), and (d) improved oxygenation versus all other postures. Semirecumbent positioning increased mainly additional cw-resistance versus supine(BAS) and supine(PROT) at base...Continue Reading

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Citations

Oct 5, 2006·Intensive Care Medicine·Stéphane LemassonClaude Guérin
Jun 13, 2006·Critical Care : the Official Journal of the Critical Care Forum·Davide ChiumelloLuciano Gattinoni
Jul 7, 2005·Intensive Care Medicine·Claude Guerin
Oct 27, 2005·Intensive Care Medicine·Spyros D MentzelopoulosSpyros G Zakynthinos
Jan 17, 2008·Chest·José Antonio FizHans Pasterkamp
Mar 11, 2009·Journal of Critical Care·Petros KopteridesApostolos Armaganidis
Aug 10, 2007·Veterinary Anaesthesia and Analgesia·Claude GuérinJean-Christophe Richard
Sep 30, 2005·Anesthesia and Analgesia·Spyros D MentzelopoulosSpyros G Zakynthinos

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