Effects of ventilation in ventral decubitus position on respiratory mechanics in adult respiratory distress syndrome.

OBJECTIVE

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).

DESIGN

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.

SETTING

The study was completed in the intensive care units of university hospitals as part of the management of the patients studied.

PATIENTS

Twelve patients (7 males, 5 females, mean age 51.8 +/- 16.6 years) suffering from ARDS of different aetiologies.

INTERVENTIONS

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.

RESULTS

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.

CONCLUSIONS

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.