Effect of prone position on hepato-splanchnic hemodynamics in acute lung injury.
OBJECTIVE
To evaluate the effects of prone position on hepato-splanchnic hemodynamics, metabolism and gut mucosal energy balance.


METHODS
Prospective clinical study.


METHODS
Medical intensive care unit in a university hospital.


METHODS
Eleven hemodynamically stable patients with acute lung injury (ALI) requiring mechanical ventilation.


METHODS
Patients were studied in the supine position, after 90 min in the prone position and after 90 min of supine repositioning.


RESULTS
In addition to global hemodynamics we measured intra-abdominal pressure (IAP, bladder), hepato-splanchnic blood flow (HSBF, steady state indocyanine green technique using a hepatic vein catheter) and gastric mucosal-arterial PCO(2) gap (PCO(2) gap, automated air tonometry). Systemic hemodynamics did not change during the whole study. Prone positioning did not significantly affect IAP. HSBF as well as splanchnic oxygen consumption remained unaltered, too. Similarly, neither liver lactate uptake nor indocyanine green extraction were influenced by positional changes. Finally, stable regional hemodynamics were accompanied by an unchanged PCO(2) gap.


CONCLUSIONS
We conclude that if IAP and systemic hemodynamics remain unaffected, the prone position in ALI patients compromises neither hepato-splanchnic perfusion nor gastric mucosal energy balance.
Matejovic
Martin
M
Intensive Care Unit, 1st Medical Department, Charles University Hospital Plzen, Alej svobody 80, 304 60 Plzen, Czech Republic. matejovic@fnplzen.cz
Rokyta
Richard
R
Radermacher
Peter
P
Krouzecky
Ales
A
Sramek
Vladimir
V
Novak
Ivan
I
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002248:Carbon Monoxide / Q000378:metabolism; D004396:Coloring Agents; D016638:Critical Illness; D004734:Energy Metabolism; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism; D006439:Hemodynamics; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D008099:Liver / Q000098:blood supply* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011312:Pressure; D016684:Prone Position; D011446:Prospective Studies; D012039:Regional Blood Flow; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D013152:Splanchnic Circulation; D018709:Statistics, Nonparametric; D016683:Supine Position
D004396:Coloring Agents; D002248:Carbon Monoxide; D007208:Indocyanine Green