Journal article
Diminishing Efficacy of Prone Positioning With Late Application in Evolving Lung Injury
Critical care medicine, Vol.49(10), pp.e1015-E1024
10/01/2021
DOI: 10.1097/CCM.0000000000005071
PMCID: PMC8448902
PMID: 33938714
Abstract
It is not known how lung injury progression during mechanical ventilation modifies pulmonary responses to prone positioning. We compared the effects of prone positioning on regional lung aeration in late versus early stages of lung injury.
Prospective, longitudinal imaging study.
Research imaging facility at The University of Pennsylvania (Philadelphia, PA) and Medical and Surgical ICUs at Massachusetts General Hospital (Boston, MA).
Anesthetized swine and patients with acute respiratory distress syndrome (acute respiratory distress syndrome).
Lung injury was induced by bronchial hydrochloric acid (3.5 mL/kg) in 10 ventilated Yorkshire pigs and worsened by supine nonprotective ventilation for 24 hours. Whole-lung CT was performed 2 hours after hydrochloric acid (Day 1) in both prone and supine positions and repeated at 24 hours (Day 2). Prone and supine images were registered (superimposed) in pairs to measure the effects of positioning on the aeration of each tissue unit. Two patients with early acute respiratory distress syndrome were compared with two patients with late acute respiratory distress syndrome, using electrical impedance tomography to measure the effects of body position on regional lung mechanics.
Gas exchange and respiratory mechanics worsened over 24 hours, indicating lung injury progression. On Day 1, prone positioning reinflated 18.9% ± 5.2% of lung mass in the posterior lung regions. On Day 2, position-associated dorsal reinflation was reduced to 7.3% ± 1.5% (p < 0.05 vs Day 1). Prone positioning decreased aeration in the anterior lungs on both days. Although prone positioning improved posterior lung compliance in the early acute respiratory distress syndrome patients, it had no effect in late acute respiratory distress syndrome subjects.
The effects of prone positioning on lung aeration may depend on the stage of lung injury and duration of prior ventilation; this may limit the clinical efficacy of this treatment if applied late.
Details
- Title: Subtitle
- Diminishing Efficacy of Prone Positioning With Late Application in Evolving Lung Injury
- Creators
- Yi Xin - University of PennsylvaniaKevin Martin - University of PennsylvaniaCaio C A Morais - Massachusetts General HospitalPaolo Delvecchio - University of PennsylvaniaSarah E Gerard - University of IowaHooman Hamedani - University of PennsylvaniaJacob Herrmann - Boston UniversityNicholas Abate - University of PennsylvaniaAustin Lenart - University of PennsylvaniaShiraz Humayun - University of PennsylvaniaUday Sidhu - University of PennsylvaniaMihail Petrov - University of PennsylvaniaKristan Reutlinger - University of PennsylvaniaTal Mandelbaum - University of PennsylvaniaIan Duncan - University of PennsylvaniaNicholas Tustison - University of VirginiaStephen Kadlecek - University of PennsylvaniaShampa Chatterjee - University of PennsylvaniaJames C Gee - University of PennsylvaniaRahim R Rizi - University of PennsylvaniaLorenzo Berra - Massachusetts General HospitalMaurizio Cereda - University of Pennsylvania
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.49(10), pp.e1015-E1024
- DOI
- 10.1097/CCM.0000000000005071
- PMID
- 33938714
- PMCID
- PMC8448902
- NLM abbreviation
- Crit Care Med
- ISSN
- 0090-3493
- eISSN
- 1530-0293
- Grant note
- R01 HL137389 / NHLBI NIH HHS R01 HL139066 / NHLBI NIH HHS T32 HL144461 / NHLBI NIH HHS
- Language
- English
- Date published
- 10/01/2021
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering
- Record Identifier
- 9984306834202771
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