Prone ventilation following witnessed pulmonary aspiration: the effect on oxygenation.
OBJECTIVE
Pulmonary aspiration is a significant cause of admission to the ITU and is associated with significant morbidity and mortality. Aspiration in the supine position produces posterior collapse/consolidation, similar to that seen in ALI/ARDS patients. Prone positioning has been shown to improve oxygenation in ALI/ARDS, but no studies have been performed on pulmonary aspiration.


METHODS
A prospective crossover study.


METHODS
Twelve-bed ITU.


METHODS
Eleven patients admitted to ITU with respiratory failure secondary to witnessed pulmonary aspiration requiring ventilation and an FIO(2) >0.50 after 12 h.


METHODS
Patients were placed in a prone position for 8 h and then turned supine for 8 h. Prone positioning was repeated if the FIO(2) remained >0.50. Ventilator settings were not altered in the study period.


RESULTS
Arterial blood gas analysis was performed every 2 h. The PaO(2)/FIO(2) gradient was calculated. Oxygenation improved on turning prone, with a significant increase in the PaO(2)/FIO(2) ratio ( P<0.01). There was a fall in this gradient on return to the supine position. There was a significant improvement in oxygenation on turning prone for the second period ( P<0.01). Overall, there was a significant improvement in the PaO(2)/FIO(2) ratio in the final supine position when compared to the first ( P<0.05).


CONCLUSIONS
This study demonstrates a significant improvement in oxygenation in the prone position in pulmonary aspiration. Early prone positioning in patients with pulmonary aspiration requiring ventilation may improve oxygenation by altering V/Q relationships similarly to ARDS, but also may aid drainage of secretions, opening up alveoli and preventing progression to established pneumonitis.
Easby
Jason
J
Critical Care Service, The James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
Abraham
Babu K
BK
Critical Care Service, The James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
Bonner
Stephen M
SM
Critical Care Service, The James Cook University Hospital, Middlesbrough, TS4 3BW, UK. Steve.Bonner@btinternet.com.
Graham
Stephen
S
Critical Care Service, The James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000628:therapy*; D016684:Prone Position; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods*