Response to the prone position in spontaneously breathing patients with hypoxemic respiratory failure.
OBJECTIVE
The prone position is used for intubated patients with adult respiratory distress syndrome (ARDS) and acute lung injury (ALI). The physiological changes associated with the prone position in nonintubated patients may be even more favorable than in intubated patients. We examined the effect of the prone position on arterial blood gases and patient compliance in four awake, nonintubated patients with hypoxemic respiratory failure.


METHODS
We present four consecutive cases of hypoxemic respiratory failure, in which mechanical ventilation was indicated. An attempt was made to avoid assisted ventilation by placing patients in the prone position, while breathing spontaneously. The effect on the clinical condition and the changes in blood gases were registered.


RESULTS
We found good patient tolerance. A rapid increase in PaO2 was found, and intubation was avoided in all patients. No significant complications were registered.


CONCLUSIONS
The prone position may prove beneficial in some cases of hypoxemic respiratory failure, even in awake patients, by avoiding mechanical ventilation and ventilator-associated complications.
Valter
C
C
Department of Anesthesiology and Intensive Care, University of Copenhagen, Copenhagen, Denmark. cvs@dadlnet.dk
Christensen
A M
AM
Tollund
C
C
Schønemann
N K
NK
D000293:Adolescent; D000368:Aged; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D016684:Prone Position; D012128:Respiratory Distress Syndrome / Q000150:complications*; D012131:Respiratory Insufficiency / Q000097:blood / Q000209:etiology / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods
D010100:Oxygen