Will Combining Partial Lung Ventilation and Prone Position Improve Arterial Oxygenation after Acute Lung Injury? Max et al. (page 796)

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Strategies for improving hypoxemia in acute respiratory distress syndrome include partial liquid ventilation (PLV) and placing patients in the prone position. Max et al. induced acute lung injury via saline lung lavage in 21 pigs to evaluate the possible additive value of combining PLV with prone position to treat acute respiratory distress syndrome. After induction of anesthesia, gas exchange and hemodynamic parameters were determined in all animals in both supine and prone positions. Then one group of 10 pigs was assigned to receive PLV with two sequential doses of 15 ml/kg perfluorocarbon after acute lung injury, while another 11 pigs received gaseous ventilation. Gas exchange and hemodynamic parameters were determined at set time points in both groups in prone and supine positions.Placing pigs in the PLV group in the prone position resulted in an increase of PaO2−before and during PLV with both doses of perfluorocarbon when compared with values after acute lung injury. PLV in the supine position was only effective at the 30-ml/kg dose. In the gaseous ventilation group, PaO2−increased when animals were prone. A significant additive improvement of arterial oxygenation was observed during combined therapy with 30 ml/kg perfluorocarbon and prone position in the PLV group compared with either therapy administered separately.