Abstract
IntroductionProne position is known to improve oxygenation in patients with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Supine upright (semirecumbent) position also exerts beneficial effects on gas exchange in this group of patients. We evaluated the effect of combining upright and prone position on oxygenation and respiratory mechanics in patients with ALI or ARDS in a prospective randomized cross-over study.MethodsAfter turning them prone from a supine position, we randomized the patients to a prone position or combined prone and upright position. After 2 hours, the position was changed to the other one for another 6 hours. The gas exchange and static compliance of the respiratory system, lungs, and chest wall were assessed in the supine position as well as every hour in the prone position.ResultsTwenty patients were enrolled in the study. The PaO2/FiO2 ratio improved significantly from the supine to the prone position and further significantly increased with additional upright position. Fourteen (70%) patients were classified as responders to the prone position, whereas 17 (85%) patients responded to the prone plus upright position compared with the supine position (P = n.s.). No statistically significant changes were found with respect to compliance.ConclusionsCombining the prone position with the upright position in patients with ALI or ARDS leads to further improvement of oxygenation.Trial registrationClinical Trials No. NCT00753129
Highlights
Prone position is known to improve oxygenation in patients with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS)
To exclude a time-dependent effect, patients were randomized into two groups: In both groups, basal measurements were performed in a supine position immediately before turning the patient prone; in group A, patients were kept in prone position without an upright position for 2 hours followed by 2 hours of prone-plus-upright position
Fourteen (70%) patients were classified as responders to a prone position, whereas 17 (85%) patients responded to a prone-plus-upright position compared with a supine position (P = n.s.)
Summary
Prone position is known to improve oxygenation in patients with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Supine upright (semirecumbent) position exerts beneficial effects on gas exchange in this group of patients. We evaluated the effect of combining upright and prone position on oxygenation and respiratory mechanics in patients with ALI or ARDS in a prospective randomized cross-over study. A supine upright (semirecumbent) position significantly improves gas exchange in patients with ALI or ARDS [8,9]. We hypothesized that in patients with ALI/ARDS, oxygenation improves when combining upright and prone positions because of changes in respiratory mechanics. We conducted a prospective, randomized study to investigate the short-term effects of combined upright and prone positioning on gas exchange and lung mechanics
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