Influence of Prone Position on Regional Ventilation/Perfusion Matching in Patients With ARDS Over Time: A Prospective Physiological Study.

We sought to investigate the short- and long-term effects of prone positioning (PP) on ventilation/perfusion matching in patients with ARDS using contrast-enhanced electrical impedance tomography (EIT). EIT measurements were performed in 18 mechanically ventilated subjects with ARDS before PP (supine position [SP]), 1 h after turning subjects to PP (PP), 3 h after PP (PP), 9 h after (PP), 16 h after PP (PP; the end of PP), and 3 h after returning to the supine position (Re-SP). The / increased gradually during the PP period (110.68 vs 158.44 vs 210.15 vs 215.22 vs 236.04 vs 163.77 mm Hg, mean values at SP, PP, PP, PP, PP, and Re-SP, respectively < .001). Global ventilation/perfusion matched percent significantly increased within PP duration (54.13% vs 63.15% vs 63.02% vs 63.75% vs 66.63% vs 57.42, < .005). Compared with SP, dorsal ventilation significantly increased at PP ( < .001) and increased gradually during PP. However, the dorsal flow commenced to improve at PP and persisted in enhancement until PP (40.61% vs 48.78% vs 50.56%, mean values at PP, PP, and PP, respectively < .05). There was a significant reduction in global Shunt-EIT percentage within PP duration, primarily localized in the dorsal area. Dead Space-EIT percentage remained unchanged during PP. Oxygenation remained improved or maintained throughout the 16-h duration of PP. Ventilation is susceptible to immediate gravitational effects; however, changes in blood flow may occur later after 9 h, which supports prolonged PP treatment. The shunt continuously decreases, but no significant changes were observed for dead space. ClinicalTrials.gov, NCT04725227. Registered on January 25, 2021.