Diminishing Efficacy of Prone Positioning With Late Application in Evolving Lung Injury.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 10 2021
01 10 2021
Historique:
pubmed:
4
5
2021
medline:
5
10
2021
entrez:
3
5
2021
Statut:
ppublish
Résumé
It is not known how lung injury progression during mechanical ventilation modifies pulmonary responses to prone positioning. We compared the effects of prone positioning on regional lung aeration in late versus early stages of lung injury. Prospective, longitudinal imaging study. Research imaging facility at The University of Pennsylvania (Philadelphia, PA) and Medical and Surgical ICUs at Massachusetts General Hospital (Boston, MA). Anesthetized swine and patients with acute respiratory distress syndrome (acute respiratory distress syndrome). Lung injury was induced by bronchial hydrochloric acid (3.5 mL/kg) in 10 ventilated Yorkshire pigs and worsened by supine nonprotective ventilation for 24 hours. Whole-lung CT was performed 2 hours after hydrochloric acid (Day 1) in both prone and supine positions and repeated at 24 hours (Day 2). Prone and supine images were registered (superimposed) in pairs to measure the effects of positioning on the aeration of each tissue unit. Two patients with early acute respiratory distress syndrome were compared with two patients with late acute respiratory distress syndrome, using electrical impedance tomography to measure the effects of body position on regional lung mechanics. Gas exchange and respiratory mechanics worsened over 24 hours, indicating lung injury progression. On Day 1, prone positioning reinflated 18.9% ± 5.2% of lung mass in the posterior lung regions. On Day 2, position-associated dorsal reinflation was reduced to 7.3% ± 1.5% (p < 0.05 vs Day 1). Prone positioning decreased aeration in the anterior lungs on both days. Although prone positioning improved posterior lung compliance in the early acute respiratory distress syndrome patients, it had no effect in late acute respiratory distress syndrome subjects. The effects of prone positioning on lung aeration may depend on the stage of lung injury and duration of prior ventilation; this may limit the clinical efficacy of this treatment if applied late.
Identifiants
pubmed: 33938714
pii: 00003246-202110000-00042
doi: 10.1097/CCM.0000000000005071
pmc: PMC8448902
mid: NIHMS1683945
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1015-e1024Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL137389
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL139066
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL144461
Pays : United States
Informations de copyright
Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Drs. Martin’s, Delvecchio’s, Humayun’s, Reutlinger’s, and Cereda’s instituions received funding from the National Institutes of Health (NIH) R01-HL137389 and NIH R01-HL139066. Drs. Hamedani, Abate, Humayun, Petrov, Reutlinger, Kadlecek, Chatterjee, Gee, Rizi, and Cereda received support for article research from the NIH. Dr. Herrmann received funding from OscillaVent, Inc and Zoll Medical Corporation. Drs. Abate’s, Kadlecek’s, and Gee’s institutions received funding from the NIH. Dr. Sidhu received funding from the Hospital of the University of Pennsylvania. Dr. Petrov disclosed work for hire. Dr. Gee received funding from the University of Electronic Science and Technology of China, retirement investments, the NIH, the European European Human Brain Project, and the United Arab Emirates University Research Office. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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