Open AccessTrendelenburg Ventilation in Patients of Acute Respiratory Distress Syndrome with Poor Lung Compliance and Diaphragmatic Dysfunction
Author(s) -
Saurabh Saigal,
Abhijeet Anand,
Rajesh Panda,
Krishnkant Bhardwaj,
Saiteja Kodamanchili,
Priyanka TN,
Gowthaman Thatta Balakrishnan,
Pranav Shrivatsav
Publication year - 2022
Publication title -
indian journal of critical care medicine/indian journal of critical care medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.317
H-Index - 30
eISSN - 1998-359X
pISSN - 0972-5229
DOI - 10.5005/jp-journals-10071-24127
Subject(s) - medicine , ards , supine position , pulmonary compliance , trendelenburg position , anesthesia , prone position , ventilation (architecture) , trendelenburg , tidal volume , diaphragmatic breathing , mechanical ventilation , respiratory distress , lung volumes , lung , respiratory system , mechanical engineering , alternative medicine , pathology , engineering
Patients with acute respiratory distress syndrome (ARDS) are generally ventilated in either 45° head elevation or prone position as they are associated with decreased incidence of ventilator-associated pneumonia and mortality, respectively. 1,2 But in patients with poor lung compliance and super-added diaphragmatic weakness/dysfunction, generating a minimum amount of adequate tidal volume (TV) would be very difficult in propped up/supine/prone position, leading to worsening hypoxia and CO 2 retention. We noticed a sustained increase in TV for patients with poor lung compliance (Cs <15 mL/cm H 2 O) and diaphragmatic dysfunction (bilateral diaphragmatic excursion <1 cm, on spontaneous breaths) when the patients are switched to Trendelenburg position with the same ventilator settings.