Soni Kapil Dev, Samanta Sukhen, Aggarwal Richa, Samanta Sujay
Department of Anesthesia & Critical Care (Trauma Centre), JPNA Trauma Centre, AIIMS, New Delhi 110029.
Department of Anesthesia & Critical Care (Trauma Centre), JPNA Trauma Centre, AIIMS, New Delhi 110029.
Am J Emerg Med. 2014 Oct;32(10):1297.e1-2. doi: 10.1016/j.ajem.2014.03.031. Epub 2014 Mar 27.
Prone ventilation for refractory acute respiratory distress syndrome (ARDS) mandates free abdomen by rolls in between chest wall and pelvic bones for better ventilation and control of airway pressure. We observed that, in patients with severe ARDS, prone ventilation with movable free abdomen produced high plateau pressure reduced by applying simple support to abdominal wall. Here, we have proposed a possible hypothesis to explain the paradoxical event in this particular group of patients. The increased alveolar volume in prone position is counteracted by reduction in rib cage diameter caused by weight of abdomen. In patients with severe ARDS in prone position, gravitational pressure transmits through abdominal support, resulting in better chest wall expansion and leading to more oxygenation and opening of the alveoli in ventral lung along with the dorsal lung portion that is usually better ventilated in prone position. There is no clinical trial regarding this particular observation. We suggest randomized trials to prove our observational findings.
对于难治性急性呼吸窘迫综合征（ARDS）患者，俯卧位通气要求在胸壁和骨盆骨之间放置滚动垫以使腹部自由，从而实现更好的通气并控制气道压力。我们观察到，在重症ARDS患者中，通过对腹壁施加简单支撑，可降低采用可移动自由腹部的俯卧位通气时产生的高平台压。在此，我们提出了一个可能的假设来解释这一特定患者群体中的矛盾现象。俯卧位时肺泡容积增加被腹部重量导致的胸廓直径减小所抵消。对于重症ARDS患者采用俯卧位时，重力通过腹部支撑传递，从而使胸壁扩张更好，导致腹侧肺以及通常在俯卧位通气较好的背侧肺部分的肺泡更多地充氧和开放。目前尚无关于这一特定观察结果的临床试验。我们建议进行随机试验以证实我们的观察结果。
