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Different concomitant diseases are accompanied by different effects of the prone position in acute respiratory failure
Critical Care volume 8, Article number: P36 (2004)
In acute respiratory failure (ARF), in particular acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), change from the supine position (SP) to the prone position (PP) can improve oxygenation by recruiting alveoli situated in dorsal-dependent regions and by alteration of the ventilation/perfusion ratio. The efficacy of this intervention is shown by the course of oxygenation index. The aim of our study is to demonstrate different effects of prone position ventilation (PPV) in ARF in patients with different concomitant diseases.
We studied 110 consecutive patients with ALI (n = 18) and ARDS (n = 92) at mean (± SE) age 66 ± 13 years in a clinical follow-up design at a surgical ICU in a university hospital using the American European consensus definition. Respiratory failure was accompanied solely or in combination by sepsis (n = 52), pneumonia (n = 66), malignant disease (n = 25), vascular disease (n = 60) or multiple trauma (n = 10) as concomitant disease.
All patients were ventilated intermittently in SP and PP (135° left-side/right-side position) for at least 6 hours/day for supportive treatment of respiratory failure. Data collection included, apart from baseline characteristics, individual oxygenation index and concomitant diseases of the patients.
Patients with ARF and sepsis showed an early (SP 165 ± 51 mmHg vs after 8 hours PP 198 ± 60 mmHg) and lasting significant increase in oxygenation (SP 165 ± 51 mmHg vs fourth day PP 243.23 ± 94 mmHg) after starting PPV. Patients with pneumonia (SP 159.0 ± 56.1 mmHg vs after 8 hours PP 192.1 ± 67.8 mmHg), vascular diseases (SP 157.1 ± 52.21 mmHg vs after 8 hours PP 193.0 ± 63.1 mmHg) or malignant diseases (SP 146.8 ± 53.8 mmHg vs after 8 hours PP 199.6 ± 74.3 mmHg) showed a visible increase in oxygenation on the first day after starting PPV but only a more or less clear improvement in the following days. Data 72–96 hours after starting PPV: pneumonia 215 ± 76.1 mmHg, vascular disease 212.7 ± 60.4 mmHg, and malignant disease 231.7 ± 61.4 mmHg. Multiple trauma patients showed a trend for better oxygenation but not a significant increase of the oxygenation index after starting PPV.
Especially, patients with ARF and sepsis showed an early and lasting increase in oxygenation after starting PPV, while those with pneumonia, vascular disease or malignant diseases showed a visible increase in oxygenation on the first day after starting PPV, and a more or less clear improvement in the following days. Multiple trauma patients showed only a trend for a better oxygenation but not a significant increase.
Concomitant diseases seem to have a remarkable influence on the effect of PPV in ARF.
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Lewejohann, J. Different concomitant diseases are accompanied by different effects of the prone position in acute respiratory failure. Crit Care 8, P36 (2004). https://doi.org/10.1186/cc2503
- Vascular Disease
- Acute Lung Injury
- Malignant Disease
- Prone Position
- Acute Respiratory Distress Syndrome