Pronation Reveals a Heterogeneous Response of Global and Regional Respiratory Mechanics in Patients With Acute Hypoxemic Respiratory Failure.
COVID-19
mechanical ventilation
prone position
respiratory distress syndrome
respiratory mechanics
Journal
Critical care explorations
ISSN: 2639-8028
Titre abrégé: Crit Care Explor
Pays: United States
ID NLM: 101746347
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
medline:
5
10
2023
pubmed:
5
10
2023
entrez:
5
10
2023
Statut:
epublish
Résumé
Experimental models suggest that prone position and positive end-expiratory pressure (PEEP) homogenize ventral-dorsal ventilation distribution and regional respiratory compliance. However, this response still needs confirmation on humans. Therefore, this study aimed to assess the changes in global and regional respiratory mechanics in supine and prone positions over a range of PEEP levels in acute respiratory distress syndrome (ARDS) patients. A prospective cohort study. Twenty-two intubated patients with ARDS caused by COVID-19 pneumonia. Electrical impedance tomography and esophageal manometry were applied during PEEP titrations from 20 cm H Global respiratory system compliance (Crs), chest wall compliance, regional lung compliance, ventilation distribution in supine and prone positions. Compared with supine position, the maximum level of Crs changed after prone position in 59% of ARDS patients ( Prone position modifies global respiratory compliance in most patients with ARDS. Only a subgroup of patients with a positive change in Crs postpronation presented a consistent improvement in dorsal ventilation and compliance. These data suggest that the response to pronation on global and regional mechanics can vary among ARDS patients, with some patients presenting more dorsal lung recruitment than others.
Identifiants
pubmed: 37795456
doi: 10.1097/CCE.0000000000000983
pmc: PMC10547249
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e0983Informations de copyright
Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
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