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Gas Exchange in the Prone Posture.
Respir Care. 2017 Aug; 62(8):1097-1110.RC

Abstract

The prone posture is known to have numerous effects on gas exchange, both under normal conditions and in patients with ARDS. Clinical studies have consistently demonstrated improvements in oxygenation, and a multi-center randomized trial found that, when implemented within 48 h of moderate-to-severe ARDS, placing subjects in the prone posture decreased mortality. Improvements in gas exchange occur via several mechanisms: alterations in the distribution of alveolar ventilation, redistribution of blood flow, improved matching of local ventilation and perfusion, and reduction in regions of low ventilation/perfusion ratios. Ventilation heterogeneity is reduced in the prone posture due to more uniform alveolar size secondary to a more uniform vertical pleural pressure gradient. The prone posture results in more uniform pulmonary blood flow when compared with the supine posture, due to an anatomical bias for greater blood flow to dorsal lung regions. Because both ventilation and perfusion heterogeneity decrease in the prone posture, gas exchange improves. Other benefits include a more uniform distribution of alveolar stress, relief of left-lower-lobe lung compression by the heart, enhanced secretion clearance, and favorable right-ventricular and systemic hemodynamics.

Authors+Show Affiliations

Department of Medicine nickj45@uw.edu.Department of Medicine.Department of Medicine. Department of Physiology and Biophysics, University of Washington School of Medicine, Seattle, Washington.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28559471

Citation

Johnson, Nicholas J., et al. "Gas Exchange in the Prone Posture." Respiratory Care, vol. 62, no. 8, 2017, pp. 1097-1110.
Johnson NJ, Luks AM, Glenny RW. Gas Exchange in the Prone Posture. Respir Care. 2017;62(8):1097-1110.
Johnson, N. J., Luks, A. M., & Glenny, R. W. (2017). Gas Exchange in the Prone Posture. Respiratory Care, 62(8), 1097-1110. https://doi.org/10.4187/respcare.05512
Johnson NJ, Luks AM, Glenny RW. Gas Exchange in the Prone Posture. Respir Care. 2017;62(8):1097-1110. PubMed PMID: 28559471.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gas Exchange in the Prone Posture. AU - Johnson,Nicholas J, AU - Luks,Andrew M, AU - Glenny,Robb W, Y1 - 2017/05/30/ PY - 2017/6/1/pubmed PY - 2018/4/25/medline PY - 2017/6/1/entrez KW - ARDS KW - acute respiratory distress syndrome KW - gas exchange KW - prone KW - respiratory failure KW - respiratory physiology SP - 1097 EP - 1110 JF - Respiratory care JO - Respir Care VL - 62 IS - 8 N2 - The prone posture is known to have numerous effects on gas exchange, both under normal conditions and in patients with ARDS. Clinical studies have consistently demonstrated improvements in oxygenation, and a multi-center randomized trial found that, when implemented within 48 h of moderate-to-severe ARDS, placing subjects in the prone posture decreased mortality. Improvements in gas exchange occur via several mechanisms: alterations in the distribution of alveolar ventilation, redistribution of blood flow, improved matching of local ventilation and perfusion, and reduction in regions of low ventilation/perfusion ratios. Ventilation heterogeneity is reduced in the prone posture due to more uniform alveolar size secondary to a more uniform vertical pleural pressure gradient. The prone posture results in more uniform pulmonary blood flow when compared with the supine posture, due to an anatomical bias for greater blood flow to dorsal lung regions. Because both ventilation and perfusion heterogeneity decrease in the prone posture, gas exchange improves. Other benefits include a more uniform distribution of alveolar stress, relief of left-lower-lobe lung compression by the heart, enhanced secretion clearance, and favorable right-ventricular and systemic hemodynamics. SN - 1943-3654 UR - https://www.unboundmedicine.com/medline/citation/28559471/Gas_Exchange_in_the_Prone_Posture_ L2 - http://rc.rcjournal.com/cgi/pmidlookup?view=short&pmid=28559471 DB - PRIME DP - Unbound Medicine ER -