Kodamanchili Saiteja, Saigal Saurabh, Anand Abhijeet, Panda Rajesh, Priyanka T N, Balakrishnan Gowthaman Thatta, Bhardwaj Krishnkant, Shrivatsav Pranav
Department of Anaesthesia and Critical Care Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Indian J Crit Care Med. 2022 Mar;26(3):319-321. doi: 10.5005/jp-journals-10071-24127.
Patients with acute respiratory distress syndrome (ARDS) are generally ventilated in either 45° head elevation or prone position as they are associated with decreased incidence of ventilator-associated pneumonia and mortality, respectively. But in patients with poor lung compliance and super-added diaphragmatic weakness/dysfunction, generating a minimum amount of adequate tidal volume (TV) would be very difficult in propped up/supine/prone position, leading to worsening hypoxia and CO retention. We noticed a sustained increase in TV for patients with poor lung compliance (Cs <15 mL/cm HO) and diaphragmatic dysfunction (bilateral diaphragmatic excursion <1 cm, on spontaneous breaths) when the patients are switched to Trendelenburg position with the same ventilator settings.
A case report with possible explanation for the observed changes has been mentioned.
Trendelenburg ventilation delivered more TV than propped up or prone ventilation in patients of ARDS with poor lung compliance and diaphragmatic dysfunction.
Trendelenburg ventilation increases static lung compliance and delivers more TV when compared to propped up/supine/prone ventilation in patients of ARDS with poor lung compliance and diaphragmatic dysfunction. Although the exact mechanism behind this is not known till now, we formulated few theories that could explain the possible mechanism.
Kodamanchili S, Saigal S, Anand A, Panda R, Priyanka TN, Balakrishnan GT, . Trendelenburg Ventilation in Patients of Acute Respiratory Distress Syndrome with Poor Lung Compliance and Diaphragmatic Dysfunction. Indian J Crit Care Med 2022;26(3):319-321.
急性呼吸窘迫综合征（ARDS）患者通常采用头部抬高45°或俯卧位通气，因为这两种体位分别与呼吸机相关性肺炎发病率降低和死亡率降低相关。但对于肺顺应性差且合并膈肌无力/功能障碍的患者，在半卧位/仰卧位/俯卧位时很难产生最低限度的充足潮气量（TV），从而导致缺氧和二氧化碳潴留加重。我们注意到，对于肺顺应性差（Cs<15 mL/cm H₂O）且存在膈肌功能障碍（自主呼吸时双侧膈肌移动度<1 cm）的患者，在呼吸机设置不变的情况下，将其转为头低脚高位时，潮气量会持续增加。
已提及一份对观察到的变化可能的解释的病例报告。
在肺顺应性差且存在膈肌功能障碍的ARDS患者中，头低脚高位通气比半卧位或俯卧位通气产生的潮气量更多。
与半卧位/仰卧位/俯卧位通气相比，头低脚高位通气可提高ARDS合并肺顺应性差和膈肌功能障碍患者的静态肺顺应性，并产生更多潮气量。尽管目前尚不清楚其确切机制，但我们提出了一些理论来解释可能的机制。
Kodamanchili S, Saigal S, Anand A, Panda R, Priyanka TN, Balakrishnan GT, . 急性呼吸窘迫综合征合并肺顺应性差和膈肌功能障碍患者的头低脚高位通气。《印度重症监护医学杂志》2022；26(3):319 - 321。
