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What is the optimal duration of ventilation in the prone position in acute lung injury and acute respiratory distress syndrome?
Intensive Care Med. 2002 Apr; 28(4):414-8.IC

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 PaO(2)/fraction of inspired oxygen (FIO(2)) 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 18 h 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.

Authors+Show Affiliations

Intensive Care Unit, Birmingham Heartlands Teaching Hospital, Bordesley Green East, Birmingham B9 5SS, UK. dan.mcauley@dtn.ntl.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11967594

Citation

McAuley, D F., et al. "What Is the Optimal Duration of Ventilation in the Prone Position in Acute Lung Injury and Acute Respiratory Distress Syndrome?" Intensive Care Medicine, vol. 28, no. 4, 2002, pp. 414-8.
McAuley DF, Giles S, Fichter H, et al. What is the optimal duration of ventilation in the prone position in acute lung injury and acute respiratory distress syndrome? Intensive Care Med. 2002;28(4):414-8.
McAuley, D. F., Giles, S., Fichter, H., Perkins, G. D., & 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), 414-8.
McAuley DF, et al. What Is the Optimal Duration of Ventilation in the Prone Position in Acute Lung Injury and Acute Respiratory Distress Syndrome. Intensive Care Med. 2002;28(4):414-8. PubMed PMID: 11967594.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - What is the optimal duration of ventilation in the prone position in acute lung injury and acute respiratory distress syndrome? AU - McAuley,D F, AU - Giles,S, AU - Fichter,H, AU - Perkins,G D, AU - Gao,F, Y1 - 2002/03/20/ PY - 2001/08/28/received PY - 2002/01/22/accepted PY - 2002/4/23/pubmed PY - 2002/8/2/medline PY - 2002/4/23/entrez SP - 414 EP - 8 JF - Intensive care medicine JO - Intensive Care Med VL - 28 IS - 4 N2 - 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 PaO(2)/fraction of inspired oxygen (FIO(2)) 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 18 h 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. SN - 0342-4642 UR - https://www.unboundmedicine.com/medline/citation/11967594/What_is_the_optimal_duration_of_ventilation_in_the_prone_position_in_acute_lung_injury_and_acute_respiratory_distress_syndrome L2 - https://dx.doi.org/10.1007/s00134-002-1248-z DB - PRIME DP - Unbound Medicine ER -