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Improved oxygenation using the prone position in patients with ARDS
Author(s) -
Flaatten H.,
Aardal S.,
Hevrøy O.
Publication year - 1998
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 - 10.1111/j.1399-6576.1998.tb04925.x
Subject(s) - medicine , prone position , supine position , ards , oxygenation , anesthesia , ventilation (architecture) , lung , mechanical engineering , engineering
Background: The prone position is known to increase oxygen uptake in patients with Adult Respiratory Distress Syndrome (ARDS). Methods: In this clinical study from 1995–96, 14 ARDS patients with severe respiratory failure were treated for at least 1 h in the prone position. Responders, defined as having more than 10% increase in PaO 2 /FiO 2 ratio from baseline after 1 h, were treated at least 6 h in the prone position. Results: 11 patients responded during the first period of the prone position (primary responders). Two of the 3 non‐responders were turned prone a second time with increase in the PaO 2 FiO 2 ratio (secondary responders). Mean PaO 2 FiO 2 ratio (mean±SEM) in the supine position was 11.7±0.8 kPa, increasing to 16.6±1.8 kPa and 18.0±1.4 kPa after 1 and 6 h respectively ( P =0.009). Mean time spent in the prone position was 69 h (range 3–256 h), and mean ventilatory time was 17 d (3–52 d). The mortality in this subgroup of our patients with ARDS was 42%, compared to 58% in 19 patients not turned prone in the same period. Conclusions: The prone position together with PEEP appears to improve ventilation‐perfusion matching. The prone position is simple, effective and readily available and could be used early in most patients with ARDS.