Effect of prone position on hepato-splanchnic hemodynamics in acute lung injury

Objective

Ventilation in prone position (PP) is a common method to improve gas exchange in patients with acute lung injury (ALI). Although no significant changes in systemic hemodynamics were observed [1], the question remains as to whether the PP may alter the hepato-splanchnic perfusion and oxygen exchange. Therefore, we studied the effects of PP on hepato-splanchnic hemodynamics in patients with ALI.

Patients and methods

Up to now five patients with ALI fulfilling criteria for PP (PaO₂/FiO₂ < 250, FiO₂ > 0.55, PEEP > 10) were studied. In addition to systemic hemodynamics (radial and PA catheters) and gas exchange, hepatosplanchnic blood flow (HSBF, steady state indocyanine green technique) and hepatic venous pressure (HVP) were measured using hepatic vein catheter. Gastric intramucosal-arterial PCO₂ gap was determined using air tonometry (Tonocap) and intravesical pressure was recorded to monitor intra-abdominal pressure (IAP). Data collection was performed at the supine position (SP1), after 90 min of PP, and after 90 min of supine repositioning (SP2).

Results

Data are median and interquartile range (RM-ANOVA).

Conclusion

Our preliminary results suggest that the prone position, provided that IAP remains unaffected [2], compromises neither the perfusion of the hepato-splanchnic area nor the gut mucosal energy status in patients with ALI [3].

Supported by a grant IGA MZ ND5649-3.

Table 1