Published ahead of print on April 27, 2006, doi:10.1164/rccm.200506-899OC Am. J. Respir. Crit. Care Med., Volume 174, Number 2, July 2006, 187-197 A more recent version of this article appeared on July 15, 2006
Submitted on June 10, 2005 Prone Position Augments Recruitment and Prevents Alveolar Overinflation in Acute Lung InjuryEftichia Galiatsou1,1 Department of Intensive Care Medicine, University Hospital of Ioannina, Ioannina, Greece, 2 Department of Clinical Radiology, University Hospital of Ioannina, Ioannina, Greece * To whom correspondence should be addressed. E-mail: gnakos{at}cc.uoi.gr.
Rationale: Mechanical ventilation in the prone position may be an effective means of recruiting non-aerated 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 were turned prone after a recruitment maneuver. Methods: In twenty one patients with acute lung injury (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. Main Results: Both recruitment maneuver and prone position resulted in improved oxygenation in patients with lobar ALI. Prone position also resulted in increased respiratory system compliance and decreased PaCO2, in lobar ALI. In lobar ALI, the proportion of over-inflated and non-aerated areas declined, while the proportion of well aerated areas increased in the prone position. The decrease in over-inflated areas was observed mainly in the ventral areas. The dorsal regions showed a decrease in non-aerated areas and increase in well-aerated areas. Recruitment maneuver and prone position improved oxygenation but had no effect either on PaCO2 or on the respiratory system compliance of patients with diffuse ALI. These patients responded to prone position with a decrease in non-aerated areas. Conclusions: Prone position recruited the edematous lung further than recruitment maneuvers and reversed over-inflation resulting in a more homogeneous distribution of aeration. The effects of proning were more pronounced in patients with lobar ALI. Key words: prone position, recruitment maneuver, acute lung injury, computed tomography, ventilator induced lung injury
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