Am. J. Respir. Crit. Care Med., Volume 157, Number 2, February 1998, 387-393

Effects of the Prone Position on Respiratory Mechanics and Gas Exchange during Acute Lung Injury

PAOLO PELOSI, DANIELA TUBIOLO, DANIELE MASCHERONI, PIERLUIGI VICARDI, STEFANIA CROTTI, FRANCO VALENZA, and LUCIANO GATTINONI

Istituto di Anestesia e Rianimazione, Università degli Studi de Milano and Servizio di Anestesia e Rianimazione, Ospedale Maggiore, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy

We studied 16 patients with acute lung injury receiving volume-controlled ventilation to assess the relationships between gas exchange and respiratory mechanics before, during, and after 2 h in the prone position. We measured the end-expiratory lung volume (EELV, helium dilution), the total respiratory system (Cst,rs), the lung (Cst,L) and the thoracoabdominal cage (Cst,w) compliances (end- inspiratory occlusion technique and esophageal balloon), the hemodynamics, and gas exchange. In the prone position, Pa_O2 increased from 103.2 ± 23.8 to 129.3 ± 32.9 mm Hg (p < 0.05) without significant changes of Cst,rs and EELV. However, Cst,w decreased from 204.8 ± 97.4 to 135.9 ± 52.5 ml/ cm H₂O (p < 0.01) and the decrease was correlated with the oxygenation increase (r = 0.62, p < 0.05). Furthermore, the greater the baseline supine Cst,w, the greater its decrease in the prone position (r = 0.82, p < 0.01). Consequently, the oxygenation changes in the prone position were predictable from baseline supine Cst,w (r = 0.80, p < 0.01). Returning to the supine position, Cst,rs increased compared with baseline (42.3 ± 14.4 versus 38.4 ± 13.7 ml/cm H₂O; p < 0.01), mainly because of the lung component (57.5 ± 25.1 versus 52.4 ± 23.3 ml/cm H₂O; p < 0.01). Thus, (1) baseline Cst,w and its changes may play a role in determining the oxygenation response in the prone position; (2) the prone position improves Cst,rs and Cst,L when the supine position is resumed.

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