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Airway pressure release ventilation and prone positioning in severe acute respiratory distress syndrome
Author(s) -
Varpula T.,
Pettilä V.,
Nieminen H.,
Takkunen O.
Publication year - 2001
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.2001.045003340.x
Subject(s) - medicine , acute respiratory distress , respiratory distress , ventilation (architecture) , airway , respiratory system , intensive care medicine , continuous positive airway pressure , anesthesia , prone position , lung , mechanical engineering , obstructive sleep apnea , engineering
Background: Implementation of lung protective strategy in the treatment of severe Acute Respiratory Distress Syndrome (ARDS) has been reported to be associated with improved outcome. To fulfil this approach, sedation, neuromuscular blocking agents and full mechanical ventilatory support are often used in critical failure of gas exchange. Case report: We present a patient who developed multiple organ failure, including severe ARDS, after severe skin injuries and septic shock. Ventilatory strategy consisted of lung protective approach, permissive hypercapnia and prone positioning. Airway pressure release ventilation (APRV) with the patient’s superimposed spontaneous breathing was implemented and maintained, also during prone episodes. Improvement of gas exhange occurred after application of combined use of APRV and prone positioning. Conclusion: APRV and maintenance of patients’ spontaneous ventilation is feasible during prone positioning, and this approach may have beneficial synergistic effects on gas exhange in patients with severe acute lung injury.