[Artificial respiration in the prone position in a case of acute respiratory distress syndrome].
A patient is presented in whom an acute respiratory distress syndrome (ARDS) developed after severe lung contusion. Exchange of gas was markedly restricted under aggressive respiration (FiO2 = 1.0, PEEP = 10 mmHg, breathing time quotient = 0.5, respiratory minute volume = 16 litres; gas exchange values: PaO2 = 67 mmHg, PaCO2 = 45 mmHg, PA-aO2 = 461 mmHg). After control of the computed tomogram of the lungs showed marked densifications in those parts of the lung that are lower most by gravitation according to the positioning of the patient at a particular time the patient was ventilated in ventricumbent (prone) position for 60 hours. After having remained in this position for 48 hours, there was a significant improvement in the gas exchange (PaO2 = 89 mmHg, PaCO2 = 36 mmHg, PA-aO2 = 77 mmHg at FiO2 = 0.3, PEEP = 6 mmHg, breathing time quotient = 0.5 and respiratory minute volume = 9 litres). The control CT in dorsal position showed that the dorsal densifications had disappeared completely. Five days later the patient could be extubated. Respiration in ventricumbent (prone) position may considerably improve oxygenation by perfusion of well-ventilated regions of the lung that are lower-most by gravitation according to the relative positioning of the patient. Besides regions not well ventilated or not ventilated at all (according to the patient's position) may be better ventilated or re-opened and made accessible to ventilation by this method.
Thülig
B
B
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Wilhelms-Universität Münster.
Hachenberg
T
T
Wendt
M
M
Wiesmann
W
W
Sulkowski
U
U
D000328:Adult; D006801:Humans; D008297:Male; D011187:Posture; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D014057:Tomography, X-Ray Computed
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