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By Ornella Pierucci Residente de terapia intensiva
Raquel S Santos, Pedro L Silva, Paolo Pelosi, Patricia Rm Rocco
Acute respiratory distress syndrome (ARDS) represents a serious problem in critically ill patients and is associated with in-hospital mortality rates of 33%-52%. Recruitment maneuvers (RMs) are a simple, low-cost, feasible intervention that can be performed at the bedside in patients with ARDS. RMs are characterized by the application of airway pressure to increase transpulmonary pressure transiently. Once non-aerated lung units are reopened, improvements are observed in respiratory system mechanics, alveolar reaeration on computed tomography, and improvements in gas exchange (functional recruitment)...
November 4, 2015: World Journal of Critical Care Medicine
L Gattinoni, E Carlesso, P Taccone, F Polli, C Guérin, J Mancebo
Prone positioning has been used for over 30 years in the management of patients with acute respiratory distress syndrome (ARDS). This maneuver has consistently proven capable of improving oxygenation in patients with acute respiratory failure. Several mechanisms can explain this observation, including possible intervening net recruitment and more homogeneously distributed alveolar inflation. It is also progressively becoming clear that prone positioning may reduce the nonphysiological stress and strain associated with mechanical ventilation, thus decreasing the risk of ventilator-induced lung injury, which is known to adversely impact patient survival...
June 2010: Minerva Anestesiologica
Antoine Vieillard-Baron, Anne Rabiller, Karin Chergui, Olivier Peyrouset, Bernard Page, Alain Beauchet, François Jardin
OBJECTIVE: We tested the hypothesis that ventilation in the prone position might improve homogenization of tidal ventilation by reducing time-constant inequalities, and thus improving alveolar ventilation. We have recently reported in ARDS patients that these inequalities are responsible for the presence of a "slow compartment," excluded from tidal ventilation at supportive respiratory rate. DESIGN: In 11 ARDS patients treated by ventilation in the prone position because of a major oxygenation impairment (PaO(2)/FIO(2)</=100 mm Hg) we studied mechanical and blood gas changes produced by a low PEEP (6+/-1 cm H(2)O), ventilation in the prone position, and the two combined...
February 2005: Intensive Care Medicine
Richard H Kallet
Prone position (PP) has been used since the 1970s to treat severe hypoxemia in patients with ARDS because of its effectiveness at improving gas exchange. Compared with the supine position (SP), placing patients in PP effects a more even tidal volume distribution, in part, by reversing the vertical pleural pressure gradient, which becomes more negative in the dorsal regions. PP also improves resting lung volume in the dorsocaudal regions by reducing the superimposed pressure of both the heart and the abdomen...
November 2015: Respiratory Care
Vittorio Scaravilli, Giacomo Grasselli, Luigi Castagna, Alberto Zanella, Stefano Isgrò, Alberto Lucchini, Nicolò Patroniti, Giacomo Bellani, Antonio Pesenti
PURPOSE: Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distress syndrome undergoing invasive ventilation. We evaluated feasibility and efficacy of PP in awake, non-intubated, spontaneously breathing patients with hypoxemic acute respiratory failure (ARF). MATERIAL AND METHODS: We retrospectively studied non-intubated subjects with hypoxemic ARF treated with PP from January 2009 to December 2014. Data were extracted from medical records...
December 2015: Journal of Critical Care
S-Y Yang, J-K Shim, Y Song, S-J Seo, Y-L Kwak
BACKGROUND: The aim of this prospective trial was to investigate the ability of pulse pressure variation (PPV) and corrected flow time (FTc) to predict fluid responsiveness in the prone position. METHODS: Forty-four patients undergoing lumbar spine surgery in the prone position on a Wilson frame were prospectively studied. PPV and FTc were measured before and after a colloid bolus (6 ml kg(-1)) both in the supine and in the prone positions. Fluid responsiveness was defined as an increase in the stroke volume index of ≥ 10% as measured by oesophageal Doppler...
May 2013: British Journal of Anaesthesia
Eftichia Galiatsou, Eleonora Kostanti, Eugenia Svarna, Athanasios Kitsakos, Vasilios Koulouras, Stauros C Efremidis, Georgios Nakos
RATIONALE: Mechanical ventilation in the prone position may be an effective means of recruiting nonaerated alveolar units and minimizing ventilation-induced lung injury. OBJECTIVES: To evaluate and quantify regional lung volume alterations when patients with lobar or diffuse acute lung injury (ALI) were turned prone after a recruitment maneuver. METHODS: In 21 patients with ALI, a recruitment maneuver was applied in the supine position followed by a multislice spiral computed tomography (CT) scan; then, patients were turned prone and a second CT scan was performed...
July 15, 2006: American Journal of Respiratory and Critical Care Medicine
Jeremy R Beitler, Shahzad Shaefi, Sydney B Montesi, Amy Devlin, Stephen H Loring, Daniel Talmor, Atul Malhotra
PURPOSE: Prone positioning for ARDS has been performed for decades without definitive evidence of clinical benefit. A recent multicenter trial demonstrated for the first time significantly reduced mortality with prone positioning. This meta-analysis was performed to integrate these findings with existing literature and test whether differences in tidal volume explain conflicting results among randomized trials. METHODS: Studies were identified using MEDLINE, EMBASE, Cochrane Register of Controlled Trials, LILACS, and citation review...
March 2014: Intensive Care Medicine
Shu Ling Hu, Hong Li He, Chun Pan, Ai Ran Liu, Song Qiao Liu, Ling Liu, Ying Zi Huang, Feng Mei Guo, Yi Yang, Hai Bo Qiu
INTRODUCTION: Prone positioning (PP) has been reported to improve the survival of patients with severe acute respiratory distress syndrome (ARDS). However, it is uncertain whether the beneficial effects of PP are associated with positive end-expiratory pressure (PEEP) levels and long durations of PP. In this meta-analysis, we aimed to evaluate whether the effects of PP on mortality could be affected by PEEP level and PP duration and to identify which patients might benefit the most from PP...
May 28, 2014: Critical Care: the Official Journal of the Critical Care Forum
Alexander B Benson, Richard K Albert
Multiple animal and human studies have shown that prone positioning improves oxygenation and reduces ventilator-induced lung injury (VILI) in the setting of acute lung injury or acute respiratory distress syndrome (ARDS). In this article, the physiologic changes explaining the improvement in oxygenation are reviewed, how prone positioning reduces VILI is described, randomized controlled trials of prone ventilation in patients with ARDS are evaluated, the complications associated with prone ventilation are summarized, suggestions are made as to how these might be reduced or avoided, and when prone ventilation should start and stop and for what duration it should be used are discussed...
December 2014: Clinics in Chest Medicine
Sachin Sud, Jan O Friedrich, Neill K J Adhikari, Paolo Taccone, Jordi Mancebo, Federico Polli, Roberto Latini, Antonio Pesenti, Martha A Q Curley, Rafael Fernandez, Ming-Cheng Chan, Pascal Beuret, Gregor Voggenreiter, Maneesh Sud, Gianni Tognoni, Luciano Gattinoni, Claude Guérin
BACKGROUND: Mechanical ventilation in the prone position is used to improve oxygenation and to mitigate the harmful effects of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). We sought to determine the effect of prone positioning on mortality among patients with ARDS receiving protective lung ventilation. METHODS: We searched electronic databases and conference proceedings to identify relevant randomized controlled trials (RCTs) published through August 2013...
July 8, 2014: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Rodrigo A Cornejo, Juan C Díaz, Eduardo A Tobar, Alejandro R Bruhn, Cristobal A Ramos, Roberto A González, Claudia A Repetto, Carlos M Romero, Luis R Gálvez, Osvaldo Llanos, Daniel H Arellano, Wilson R Neira, Gonzalo A Díaz, Aníbal J Zamorano, Gonzalo L Pereira
RATIONALE: Positive end-expiratory pressure (PEEP) and prone positioning may induce lung recruitment and affect alveolar dynamics in acute respiratory distress syndrome (ARDS). Whether there is interdependence between the effects of PEEP and prone positioning on these variables is unknown. OBJECTIVES: To determine the effects of high PEEP and prone positioning on lung recruitment, cyclic recruitment/derecruitment, and tidal hyperinflation and how these effects are influenced by lung recruitability...
August 15, 2013: American Journal of Respiratory and Critical Care Medicine
C Guerin, L Baboi, J C Richard
INTRODUCTION: Prone positioning has been used for many years in patients with acute respiratory distress syndrome (ARDS). The initial reason for prone positioning in ARDS patients was improvement in oxygenation. It was later shown that mechanical ventilation in the prone position can be less injurious to the lung and hence the primary reason to use prone positioning is prevention of ventilator-induced lung injury (VILI). MATERIAL AND METHODS: A large body of physiologic benefits of prone positioning in ARDS patients accumulated but these failed to translate into clinical benefits...
November 2014: Intensive Care Medicine
Claude Guérin, Jean Reignier, Jean-Christophe Richard, Pascal Beuret, Arnaud Gacouin, Thierry Boulain, Emmanuelle Mercier, Michel Badet, Alain Mercat, Olivier Baudin, Marc Clavel, Delphine Chatellier, Samir Jaber, Sylvène Rosselli, Jordi Mancebo, Michel Sirodot, Gilles Hilbert, Christian Bengler, Jack Richecoeur, Marc Gainnier, Frédérique Bayle, Gael Bourdin, Véronique Leray, Raphaele Girard, Loredana Baboi, Louis Ayzac
BACKGROUND: Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS. METHODS: In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine position...
June 6, 2013: New England Journal of Medicine
R Carrasco Loza, G Villamizar Rodríguez, N Medel Fernández
Acute Respiratory Distress Syndrome (ARDS) is a clinical condition secondary to a variety of insults leading to a severe acute respiratory failure and high mortality in critically ill patients. Patients with ARDS generally require mechanical ventilation, which is another important factor that may increase the ALI (acute lung injury) by a series of pathophysiological mechanisms, whose common element is the initial volutrauma in the alveolar units, and forming part of an entity known clinically as ventilator-induced lung injury (VILI)...
2015: Open Respiratory Medicine Journal
Ryoichi Ochiai
Acute respiratory distress syndrome (ARDS) has been intensively and continuously studied in various settings, but its mortality is still as high as 30-40 %. For the last 20 years, lung protective strategy has become a standard care for ARDS, but we still do not know the best way to ventilate patients with ARDS. Tidal volume itself does not seem to have an important role to develop ventilator-induced lung injury (VILI), but the driving pressure, which is inspiratory plateau pressure-PEEP, is the most important to predict and affect the outcome of ARDS, though there is no safe limit for the driving pressure...
2015: Journal of Intensive Care
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