Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany.
Semin Respir Crit Care Med. 2019 Feb;40(1):94-100. doi: 10.1055/s-0039-1685180. Epub 2019 May 6.
Prone positioning is nowadays considered as one of the most effective strategies for patients with severe acute respiratory distress syndrome (ARDS). The evolution of the pathophysiological understanding surrounding the prone position closely follows the history of ARDS. At the beginning, the focus of the prone position was the improvement in oxygenation attributed to a perfusion redistribution. However, the mechanisms behind the prone position are more complex. Indeed, the positive effects on oxygenation and CO clearance of the prone position are to be ascribed to a more homogeneous inflation-ventilation, to the lung/thoracic shape mismatch, and to the change of chest wall elastance. In the past 20 years, five major trials have tried, starting from different theories, hypotheses, and designs, to demonstrate the effectiveness of the prone position, which finally found its definitive place among the different ARDS supportive therapies.
俯卧位通气现如今被认为是治疗严重急性呼吸窘迫综合征（ARDS）患者的最有效策略之一。围绕俯卧位的病理生理学认识的发展与 ARDS 的历史密切相关。起初，俯卧位的重点是改善氧合，这归因于灌注再分布。然而，俯卧位的机制更为复杂。事实上，俯卧位对氧合和 CO 清除的积极影响可归因于更均匀的膨胀-通气、肺/胸廓形状不匹配以及胸壁弹性的变化。在过去的 20 年中，有五项主要的试验从不同的理论、假说和设计出发，试图证明俯卧位的有效性，最终使其在不同的 ARDS 支持治疗中找到了明确的位置。
