Prone position improves mechanics and alveolar ventilation in acute respiratory distress syndrome.
OBJECTIVE
We tested the hypothesis that ventilation in the prone position might improve homogenization of tidal ventilation by reducing time-constant inequalities, and thus improving alveolar ventilation. We have recently reported in ARDS patients that these inequalities are responsible for the presence of a "slow compartment," excluded from tidal ventilation at supportive respiratory rate.


METHODS
In 11 ARDS patients treated by ventilation in the prone position because of a major oxygenation impairment (PaO(2)/FIO(2)</=100 mm Hg) we studied mechanical and blood gas changes produced by a low PEEP (6+/-1 cm H(2)O), ventilation in the prone position, and the two combined.


RESULTS
Ventilation in the prone position significantly reduced the expiratory time constant from 1.98+/-0.53 s at baseline with ZEEP to 1.53+/-0.34 s, and significantly decreased PaCO(2) from 55+/-11 mm Hg at baseline with ZEEP to 50+/-7 mm Hg. This improvement in alveolar ventilation was accompanied by a significant improvement in respiratory system mechanics, and in arterial oxygenation, the latter being markedly increased by application of a low PEEP (PaO(2)/FIO(2) increasing from 64+/-19 mm Hg in supine position with ZEEP to 137+/-88 mm Hg in prone with a low PEEP).


CONCLUSIONS
In severely hypoxemic patients, prone position was able to improve alveolar ventilation significantly by reducing the expiratory time constant.
Vieillard-Baron
Antoine
A
Medical Intensive Care Unit, University Hospital Ambroise Paré, Assistance Publique Hôpitaux de Paris, 9 avenue Charles de Gaulle, 92104, Boulogne Cedex, France.
Rabiller
Anne
A
Chergui
Karin
K
Peyrouset
Olivier
O
Page
Bernard
B
Beauchet
Alain
A
Jardin
François
F
D000704:Analysis of Variance; D001784:Blood Gas Analysis; D005260:Female; D006801:Humans; D008170:Lung Compliance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D016684:Prone Position / Q000502:physiology*; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology*; D015656:Respiratory Mechanics; D018709:Statistics, Nonparametric