Cakar N, der Kloot T V, Youngblood M, Adams A, Nahum A
Department of Anesthesiology and Intensive Care, University of Istanbul, Istanbul Medical Faculty Capa, Istanbul, Turkey.
Am J Respir Crit Care Med. 2000 Jun;161(6):1949-56. doi: 10.1164/ajrccm.161.6.9907113.
Prone position and recruitment maneuvers (RM) are proposed as adjuncts to mechanical ventilation to open up the lung and keep it open. We studied the oxygenation response to a RM (composed of a 30-s sustained inflation at 60 cm H(2)O airway pressure) performed in prone and supine positions in dogs after oleic acid- induced lung injury using an inspired O(2) fraction of 0.60. In one group (n = 6) first supine then prone positions were examined after a RM at 8 cm H(2)O and 15 cm H(2)O of positive end-expiratory pressure (PEEP). In the second group (n = 6) the sequence of positions was reversed. Prone positioning after supine position always improved oxygenation, whereas the decrement in Pa(O(2)) was relatively small when dogs were returned to the supine position. Oxygenation improved in both groups after a RM, and the improvement was sustained (after 15 min) in the prone position at 8 cm H(2)O of PEEP, but 15 cm H(2)O of PEEP was required in supine position. Our results suggest that a RM improves oxygenation more effectively with a decreased PEEP requirement for the preservation of the oxygenation response in prone compared with supine position.
俯卧位和肺复张手法（RM）被提议作为机械通气的辅助手段，以打开肺并保持其开放状态。我们使用0.60的吸入氧分数，研究了油酸诱导的犬肺损伤后，在俯卧位和仰卧位进行RM（由在60 cm H₂O气道压力下持续30秒的膨胀组成）时的氧合反应。在一组（n = 6）中，在8 cm H₂O和15 cm H₂O的呼气末正压（PEEP）下进行RM后，先检查仰卧位然后检查俯卧位。在第二组（n = 6）中，体位顺序相反。仰卧位后转为俯卧位总能改善氧合，而当犬回到仰卧位时，Pa(O₂)的下降相对较小。两组在RM后氧合均有改善，在8 cm H₂O的PEEP下俯卧位时改善持续（15分钟后），但仰卧位时需要15 cm H₂O的PEEP。我们的结果表明，与仰卧位相比，RM在俯卧位能更有效地改善氧合，且维持氧合反应所需的PEEP降低。
