Servillo G, Roupie E, De Robertis E, Rossano F, Brochard L, Lemaire F, Tufano R
Institute of Anaesthesiology and Intensive Care Medicine, University of Naples, Frederico II, Italy.
Intensive Care Med. 1997 Dec;23(12):1219-24. doi: 10.1007/s001340050489.
To assess the potential benefits of a period of ventilation in ventral decubitus (VD) on oxygenation and respiratory mechanics in the adult respiratory distress syndrome (ARDS).
In a stable condition during baseline ventilation in dorsal decubitus (DD), after 15 min of ventilation in VD and after 10 min of restored DD, the following parameters were studied: arterial blood gas tension, haemodynamics and static respiratory compliance (Crs), evaluated with the rapid airway occlusion technique.
The study was completed in the intensive care units of university hospitals as part of the management of the patients studied.
Twelve patients (7 males, 5 females, mean age 51.8 +/- 16.6 years) suffering from ARDS of different aetiologies.
Before and during each evaluation, the patients were kept under stable haemodynamic and metabolic conditions. The ventilatory setting was kept constant. All the patients were sedated, paralysed and mechanically ventilated.
A statistically significant increase in the ratio between the arterial partial pressure of oxygen and fractional inspired oxygen (p < 0.01) was observed between the baseline conditions (mean 123.9 +/- 22.6) and VD (mean 153.0 +/- 16.9), while no statistical significant was noted between baseline conditions and after 10 min of restored DD (mean 141.1 +/- 19.7). A significant increase in Crs (p < 0.001) was observed between baseline conditions (mean 42 +/- 10.1) and VD (mean 48.8 +/- 9.6) and between baseline conditions and restored DD (mean 44.7 +/- 10.6). Two patients were considered nonresponders. All the patients were haemodynamically stable. No side effects were noted.
We observed an increase in oxygenation and Crs when the patients were turned from the supine to the prone position with the upper thorax and pelvis supported.
评估成年呼吸窘迫综合征（ARDS）患者采用腹卧位通气一段时间对氧合及呼吸力学的潜在益处。
在背卧位（DD）基线通气稳定状态下、腹卧位（VD）通气15分钟后以及恢复背卧位通气10分钟后，研究以下参数：采用快速气道阻断技术评估动脉血气张力、血流动力学及静态呼吸顺应性（Crs）。
该研究在大学医院重症监护病房完成，作为所研究患者治疗的一部分。
12例不同病因的ARDS患者（7例男性，5例女性，平均年龄51.8±16.6岁）。
在每次评估前及评估期间，使患者保持血流动力学和代谢稳定。通气设置保持不变。所有患者均接受镇静、肌松并进行机械通气。
基线状态（平均123.9±22.6）与腹卧位时（平均153.0±16.9）相比，动脉血氧分压与吸入氧分数之比有统计学显著升高（p<0.01），而基线状态与恢复背卧位通气10分钟后（平均141.1±19.7）相比无统计学显著差异。基线状态（平均42±10.1）与腹卧位时（平均48.8±9.6）以及基线状态与恢复背卧位后（平均44.7±10.6）相比，Crs均有显著升高（p<0.001）。2例患者被视为无反应者。所有患者血流动力学稳定。未观察到副作用。
我们观察到，当患者在胸部上方和骨盆得到支撑的情况下由仰卧位转为俯卧位时，氧合及Crs增加。
