Published ahead of print on December 18, 2002, doi:10.1164/rccm.200203-198OC Am. J. Respir. Crit. Care Med., Volume 167, Number 4, February 2003, 521-527 A more recent version of this article appeared on February 15, 2003
Submitted on March 31, 2002 SIGH IN SUPINE AND PRONE POSITION DURING ACUTE RESPIRATORY DISTRESS SYNDROMEPaolo Pelosi1,1 Dipartimento di Scienze Cliniche e Biologiche, Universita degli Studi dell'Insubria, Varese, Italy, 2 Istituto di Anestesia e Rianimazione, Universita degli Studi di Milano, Milano, Italy, 3 Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA * To whom correspondence should be addressed. E-mail: gattinon{at}polic.cilea.it.
Interventions aimed at recruiting the lung of patients with acute respiratory distress syndrome (ARDS) are not uniformly effective. Because the prone position increases homogeneity of inflation of the lung, we reasoned that it may enhance its potential for recruitment. We ventilated ten patients with early ARDS (PaO2/FiO2121±46 mm Hg, PEEP 14±3 cm H2O)in supine and prone, with and without the addition of three consecutive "sighs" per minute to recruit the lung. Inspired oxygen fraction, positive end-expiratory pressure and minute ventilation were kept constant. Sighs increased PaO2 in both supine and prone (p<0.01). The highest values of PaO2 (192±41 mm Hg)and end-expiratory lung volume (1,840±790 mls) occured with the addition of sighs in prone, and remained significantly elevated one hour after discontinuation of the sighs. The increase in PaO2 associated with the sighs, both in supine and prone, correlated linearly with the respective increase of end-expiratory lung volume (r=0.82, p<0.001). We conclude that adding a recruitment maneuver such as cyclical sighs during ventilation in the prone position may provide optimal lung recruitment in the early stage of ARDS. Key words: ARDS, mechanical ventilation, recruitment, derecruitment, end-expiratory lung volume.
This article has been cited by other articles:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
