Abstract
Patients with mono-lateral pneumonia and severe respiratory failure can be positioned in lateral decubitus, with the healthy lung dependent, to improve ventilation-perfusion coupling. Oxygenation response to this manoeuvre is heterogeneous and derecruitment of dependent lung has not been elucidated. Nine pigs (32.2 ± 1.2 kg) were sedated and mechanically ventilated. Mono-lateral right-sided pneumonia was induced with intrabronchial challenge of Pseudomonas aeruginosa. After 24 h, lungs were recruited and the animals were randomly positioned on right or left side. After 3 h of lateral positioning, the animals were placed supine; another recruitment manoeuvre was performed, and the effects of contralateral decubitus were assessed. Primary outcome was lung ultrasound score (LUS) of the dependent lung after 3-h lateral positioning. LUS of the left non-infected lung worsened while positioned in left-lateral position (from 1.33 ± 1.73 at baseline to 6.78 ± 4.49; p = 0.005). LUS of the right-infected lung improved when placed upward (9.22 ± 2.73 to 6.67 ± 3.24; p = 0.09), but worsened in right-lateral position (7.78 ± 2.86 to 13.33 ± 3.08; p < 0.001). PaO2/FiO2 improved in the left-lateral position (p = 0.005). In an animal model of right-lung pneumonia, left-lateral decubitus improved oxygenation, but collapsed the healthy lung. Right-lateral orientation further collapsed the diseased lung. Our data raise potential clinical concerns for the use of lateral position in mono-lateral pneumonia.
Highlights
Patients with mono-lateral pneumonia and severe respiratory failure can be positioned in lateral decubitus, with the healthy lung dependent, to improve ventilation-perfusion coupling
As for the infected right-lung, a trend towards decreasing lung ultrasound score (LUS) score was observed after 3 h of decubitus on the left side (− 2.55 ± 0.88; p = 0.09), ∆LUS significantly worsened in right-lateral position (+ 5.56 ± 0.88; p < 0.001)
In animals with severe mono-lateral right pneumonia, we comprehensively evaluated aeration dynamics during change in side of lateral position
Summary
Patients with mono-lateral pneumonia and severe respiratory failure can be positioned in lateral decubitus, with the healthy lung dependent, to improve ventilation-perfusion coupling. Oxygenation response to this manoeuvre is heterogeneous and derecruitment of dependent lung has not been elucidated. In an animal model of right-lung pneumonia, left-lateral decubitus improved oxygenation, but collapsed the healthy lung. Severe mono-lateral pneumonia is one of the most challenging situations, since invasive mechanical ventilation (MV) is often needed to maintain adequate gas exchange, while substantial imbalance in pulmonary mechanics ensues between the healthy highly compliant lung and the stiff diseased lung. In the most severe cases, clinicians often place the patient onto lateral decubitus, with the healthy lung dependent, to improve ventilation-perfusion coupling and oxygenation[3]. Recruitment of the non-dependent infected lung is desirable, and redistribution of ventilation has been o bserved[4,5,6,7]
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