Department of General Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China.
Med Hypotheses. 2009 Nov;73(5):821-3. doi: 10.1016/j.mehy.2009.03.023. Epub 2009 Aug 14.
Use of body positioning to improve oxygenation in mechanically ventilated patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) has been well documented. However, neither prone position ventilation nor side lying ventilation has been reported to improve the survival. Whether there is a body position superior to routine supine position or other positions as therapeutic adjunct for ventilated patients with ALI and ARDS? We propose the hypothesis that upright position ventilation may be helpful to improve oxygenation and benefit patients with ALI/ARDS. According to the existing physiologic and pathophysiologic data of upright position investigation, we suppose that improvement of V/Q matching, increased functional residual capacity, alveolar recruitment, accelerated diaphragm recovery, early gastric emptying and enteric feeding may be a potential protect mechanism of upright position ventilation. Whether this can be translated into improvement in patient outcome should be further tested in clinical trial.
体位的使用改善了急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）机械通气患者的氧合作用，这已经得到了充分的证明。然而，无论是俯卧位通气还是侧卧位通气都没有报道能够改善生存率。是否有一种体位优于常规仰卧位或其他体位，可以作为治疗ALI 和 ARDS 机械通气患者的辅助手段？我们提出了一个假设，即直立位通气可能有助于改善氧合作用并使 ALI/ARDS 患者受益。根据直立位研究的现有生理和病理生理数据，我们假设改善通气/血流比、增加功能残气量、肺泡复张、加速膈肌恢复、早期胃排空和肠内喂养可能是直立位通气的一种潜在保护机制。这是否可以转化为改善患者的预后，应该在临床试验中进一步测试。
