Roche-Campo Ferran, Aguirre-Bermeo Hernan, Mancebo Jordi
Hospital Sant Pau, Servei de Medicina Intensiva, Barcelona, Spain.
Presse Med. 2011 Dec;40(12 Pt 2):e585-94. doi: 10.1016/j.lpm.2011.03.019. Epub 2011 Nov 9.
Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure. It remains one of the most devastating conditions in the intensive care unit. Mechanical ventilation with positive end-expiratory pressure is a cornerstone therapy for ARDS patients. One adjuvant alternative is to place the patient in a prone position. Since it was first described in 1976, prone positioning has been safely employed to improve oxygenation in many patients with ARDS. Prone positioning may also minimize secondary lung injury induced by mechanical ventilation, although this benefit has not been investigated as extensively, despite its potential. In spite of a strong physiological justification, prone positioning is still not widely accepted as an adjunct therapy in ARDS patients and it is only used regularly in only 10% of ICUs. This may be explained in part by the reluctance to change position, risks and unclear effects on relevant outcomes. In this paper, we review all aspects of prone positioning, from the pathophysiology to the clinical studies of patient outcome, and we also discuss the latest controversies surrounding this treatment.
急性呼吸窘迫综合征（ARDS）是一种严重的呼吸衰竭形式。它仍然是重症监护病房中最具破坏性的病症之一。呼气末正压机械通气是ARDS患者的基石疗法。一种辅助替代方法是让患者俯卧。自1976年首次描述以来，俯卧位已被安全地用于改善许多ARDS患者的氧合。俯卧位还可将机械通气引起的继发性肺损伤降至最低，尽管尽管其具有潜在益处，但尚未对此进行广泛研究。尽管有充分的生理学依据，但俯卧位在ARDS患者中仍未被广泛接受为辅助治疗方法，仅在10%的重症监护病房中定期使用。这可能部分是由于不愿改变体位、风险以及对相关结局的影响不明确所致。在本文中，我们回顾了俯卧位的各个方面，从病理生理学到患者结局的临床研究，并且我们还讨论了围绕这种治疗的最新争议。
