Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury

Torsten Richter; Giacomo Bellani; R. Scott Harris; Marcos F VIDAL MELO; Tilo Winkler; Jose G Venegas; Guido Musch

doi:10.1164/rccm.200501-004OC

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Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury

Journal article

Open access

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Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury

Torsten Richter, Giacomo Bellani, R. Scott Harris, Marcos F VIDAL MELO, Tilo Winkler, Jose G Venegas and Guido Musch

American journal of respiratory and critical care medicine, Vol.172(4), pp.480-487

08/15/2005

DOI: 10.1164/rccm.200501-004OC

PMCID: PMC2718529

PMID: 15901611

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https://www.ncbi.nlm.nih.gov/pmc/articles/2718529View

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Abstract

Rationale: The prone position is used to improve gas exchange in patients with acute respiratory distress syndrome. However, the regional mechanism by which the prone position improves gas exchange in acutely injured lungs is still incompletely defined. Methods: We used positron emission tomography imaging of [13N]nitrogen to assess the regional distribution of pulmonary shunt, aeration, perfusion, and ventilation in seven surfactant-depleted sheep in supine and prone positions. Results: In the supine position, the dorsal lung regions had a high shunt fraction, high perfusion, and poor aeration. The prone position was associated with an increase in lung gas content and with a more uniform distribution of aeration, as the increase in aeration in dorsal lung regions was not offset by loss of aeration in ventral regions. Consequently, the shunt fraction decreased in dorsal regions in the prone position without a concomitant impairment of gas exchange in ventral regions, thus leading to a significant increase in the fraction of pulmonary perfusion participating in gas exchange. In addition, the vertical distribution of specific alveolar ventilation became more uniform in the prone position. A biphasic relation between regional shunt fraction and gas fraction showed low shunt for values of gas fraction higher than a threshold, and a steep linear increase in shunt for lower values of gas fraction. Conclusion: In a surfactant-deficient model of lung injury, the prone position improved gas exchange by restoring aeration and decreasing shunt while preserving perfusion in dorsal lung regions, and by making the distribution of ventilation more uniform.

Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy

Biological and medical sciences

Blood. Blood coagulation. Reticuloendothelial system

Emergency and intensive respiratory care

Intensive care medicine

Medical sciences

Pharmacology. Drug treatments

Details

Title: Subtitle: Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury
Creators: Torsten Richter - Massachusetts General Hospital
Giacomo Bellani - University Hospital Carl Gustav Carus
R. Scott Harris - Massachusetts General Hospital
Marcos F VIDAL MELO - Clinic of Anesthesiology and Intensive Care Medicine, University Clinic Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
Tilo Winkler - Massachusetts General Hospital
Jose G Venegas - Harvard University
Guido Musch - Harvard University
Resource Type: Journal article
Publication Details: American journal of respiratory and critical care medicine, Vol.172(4), pp.480-487
DOI: 10.1164/rccm.200501-004OC
PMID: 15901611
PMCID: PMC2718529
NLM abbreviation: Am J Respir Crit Care Med
ISSN: 1073-449X
eISSN: 1535-4970
Publisher: American Lung Association
Number of pages: 8
Language: English
Date published: 08/15/2005
Academic Unit: Anesthesia
Record Identifier: 9985141866602771

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