Langer M, Mascheroni D, Marcolin R, Gattinoni L
Istituto di Anestesiologia e Rianimazione, Università di Milano, Italy.
Chest. 1988 Jul;94(1):103-7. doi: 10.1378/chest.94.1.103.
The gas exchange and hemodynamics were evaluated before, during, and after a two-hour period of prone position in 13 moderate-severe ARDS patients. Lung computerized tomography was obtained in both the supine and prone positions in two of these patients. Average arterial oxygenation improved after prone positioning (p less than 0.01). A PaO2 improvement of at least 10 mm Hg after 30 minutes of prone position was used as a criterion to discriminate between responders and nonresponders to the postural change. Eight patients met the "responders" group criterion, and in the five nonresponder patients, the PaO2 did not change significantly throughout the study. Computerized tomograms in the prone position showed disappearance of posterobasal densities and appearance of new densities in the anterior regions, in both patients studied. One of these was a responder, the other a nonresponder. A brief test period in prone position is indicated in ARDS patients to identify those who may benefit from this postural treatment. The definite mechanism of the arterial oxygenation improvement observed remains to be clarified.
对13例中重度急性呼吸窘迫综合征（ARDS）患者在俯卧位两小时期间及前后进行了气体交换和血流动力学评估。其中两名患者在仰卧位和俯卧位均进行了肺部计算机断层扫描。俯卧位后平均动脉血氧合改善（p<0.01）。以俯卧位30分钟后动脉血氧分压（PaO2）至少改善10mmHg作为区分对体位改变有反应者和无反应者的标准。8例患者符合“有反应者”组标准，在5例无反应患者中，整个研究过程中PaO2无显著变化。在接受研究的两名患者中，俯卧位计算机断层扫描显示后基底密度消失，前部区域出现新的密度。其中一名是有反应者，另一名是无反应者。建议对ARDS患者进行短时间俯卧位试验，以确定哪些患者可能从这种体位治疗中获益。观察到的动脉血氧合改善的确切机制仍有待阐明。
