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Computed tomograms from a patient with acute respiratory distress syndrome in the supine and prone positions. Atelectatic dorsal lung regions are recruited in the prone position, without equivalent compression and derecruitment in ventral regions. (From Reference 40, with permission.)
Source publication
Prone positioning has been known for decades to improve oxygenation in animals with acute lung injury and in most patients with acute respiratory distress syndrome (ARDS). The mechanisms of this improvement include a more uniform pleural-pressure gradient, a smaller volume of lung compressed by the heart, and more uniform and better-matched ventila...
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Introduction
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Background
Hemodynamic perturbations in heart failure with preserved ejection fraction (HFpEF) may alter the distribution of blood in the lungs, impair gas transfer from the alveoli into the pulmonary capillaries, and reduce lung diffusing capacity. We hypothesized that impairments in lung diffusing capacity for carbon monoxide (DL CO ) in HFpEF wo...
Key points
Precapillary gas exchange for oxygen has been documented in both humans and animals.
It has been suggested that, if precapillary gas exchange occurs to a greater extent for inert gases than for oxygen, shunt and its effects on arterial oxygenation may be underestimated by the multiple inert gas elimination technique (MIGET).
We evaluated...
Citations
... Es así que los mecanismos, gracias a los cuales la posición en decúbito prono mejora la oxigenación, se basan en cambios en la distribución de la ventilaciónperfusión en las zonas dependientes pulmonares, así como en el efecto de la gravedad, liberación del peso del corazón, disminución de las presiones pulmonares y reducción en la respuesta infl amatoria que condiciona el VILI (lesión pulmonar inducida por el ventilador por su siglas en inglés). [10][11][12] La respuesta clínica a la ventilación en decúbito prono es valorada por la gasometría arterial, considerándose oxígeno-respondedores cuando el paciente presenta un incremento de al menos 20% en la relación PaO 2 / FiO 2 respecto a la inicial o incremento de ≥ 20 mmHg en la misma relación, o bien CO 2 -respondedores cuando presentan disminución de la PaCO 2 de al menos ≥ 1 mmHg. A su vez los respondedores pueden ser considerados persistentes o no persistentes de acuerdo con la PaO 2 al cambio a la posición supina. ...
Introducción:
La neumonía grave por SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) ocasiona hipoxemia severa, por lo anterior, las guías para el manejo de pacientes adultos críticamente enfermos con COVID-19 recomiendan el uso de la posición decúbito prono para mejorar la oxigenación.
Material y métodos:
Estudio de cohorte, prospectivo, descriptivo y analítico. Pacientes ingresados a la unidad de cuidados intensivos en el periodo comprendido entre el 18 de abril de 2020 y el 18 de agosto de 2021 con ventilación mecánica invasiva (VMI) secundaria a neumonía grave por SARS-CoV-2 confirmados.
Resultados:
En el periodo comprendido se incluyeron 110 pacientes que cumplieron con los criterios de inclusión. Del total, 88 pacientes se incluyeron en el grupo de mejoría sostenida al retiro del prono y 22 en el grupo de mejoría no sostenida al retiro del prono. Se observó que la disminución del porcentaje de la PaO2/FiO2 al retiro del prono es útil para predecir mortalidad con ABC de 0.740 con IC95% de (0.646-0.834) y p = 0.001.
Conclusión:
La disminución > 50% de la PaO2/FiO2 al retiro de la posición decúbito prono prolongado o mejoría no sostenida es un predictor de mortalidad en los pacientes con neumonía grave por SARS-CoV-2.
... The response of different causes of ARDS to the prone positioning was also different. [50][51][52][53][54][55] The number of patients included in the present study was small and most of them were COVID-19 patients. A limited number of patients with other causes of pneumonia, trauma and drowning exhibited significantly improved PaO 2 /FiO 2 ratios and SpO 2 for the two groups. ...
Background and aims
The application of prone positioning with acute hypoxemic respiratory failure (AHRF) or acute respiratory distress syndrome (ARDS) in non-intubation patients is increasing gradually, applying prone positioning for more high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) patients. This meta-analysis evaluates the efficacy and tolerance of prone positioning combined with non-invasive respiratory support in patients with AHRF or ARDS.
Methods
We searched randomized controlled trials (RCTs) (prospective or retrospective cohort studies, RCTs and case series) published in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from 1 January 2000 to 1 July 2020. We included studies that compared prone and supine positioning with non-invasive respiratory support in awake patients with AHRF or ARDS. The meta-analyses used random effects models. The methodological quality of the RCTs was evaluated using the Newcastle–Ottawa quality assessment scale.
Results
A total of 16 studies fulfilled selection criteria and included 243 patients. The aggregated intubation rate and mortality rate were 33% [95% confidence interval (CI): 0.26–0.42, I² = 25%], 4% (95% CI: 0.01–0.07, I² = 0%), respectively, and the intolerance rate was 7% (95% CI: 0.01–0.12, I² = 5%). Prone positioning increased PaO2/FiO2 [mean difference (MD) = 47.89, 95% CI: 28.12–67.66; p < 0.00001, I² = 67%] and SpO2 (MD = 4.58, 95% CI: 1.35–7.80, p = 0.005, I² = 97%), whereas it reduced respiratory rate (MD = −5.01, 95% CI: −8.49 to −1.52, p = 0.005, I² = 85%). Subgroup analyses demonstrated that the intubation rate of shorter duration prone (⩽5 h/day) and longer duration prone (>5 h/day) were 34% and 21%, respectively; and the mortality rate of shorter duration prone (⩽5 h/day) and longer duration prone (>5 h/day) were 6% and 0%, respectively. PaO2/FiO2 and SpO2 were significantly improved in COVID-19 patients and non-COVID-19 patients.
Conclusion
Prone positioning could improve the oxygenation and reduce respiratory rate in both COVID-19 patients and non-COVID-19 patients with non-intubated AHRF or ARDS.
The reviews of this paper are available via the supplemental material section.
... Os mecanismos dessa melhora incluem um gradiente de pressão pleural mais uniforme e menos compressão do pulmão pelo coração, bem como uma distribuição mais uniforme e uma melhor combinação entre ventilação e perfusão. (34) Além desses efeitos fisiológicos, constatamos que, na posição prona, houve alterações estruturais nos pulmões; isto é, as áreas pulmonares dorsais foram preservadas quanto à lesão histológica e inflamatória. Um estudo anterior realizado por nosso grupo mostrou que a VOAF desempenha um importante papel protetor na LPA, melhorando a oxigenação, minimizando os processos inflamatórios, reduzindo o dano histológico e atenuando a lesão pulmonar oxidativa, mostrando-se superior à VMC protetora nesses aspectos. ...
Objective:
To compare the effects that prone and supine positioning during high-frequency oscillatory ventilation (HFOV) have on oxygenation and lung inflammation, histological injury, and oxidative stress in a rabbit model of acute lung injury (ALI).
Methods:
Thirty male Norfolk white rabbits were induced to ALI by tracheal saline lavage (30 mL/kg, 38°C). The injury was induced during conventional mechanical ventilation, and ALI was considered confirmed when a PaO2/FiO2 ratio < 100 mmHg was reached. Rabbits were randomly divided into two groups: HFOV in the supine position (SP group, n = 15); and HFOV with prone positioning (PP group, n = 15). For HFOV, the mean airway pressure was initially set at 16 cmH2O. At 30, 60, and 90 min after the start of the HFOV protocol, the mean airway pressure was reduced to 14, 12, and 10 cmH2O, respectively. At 120 min, the animals were returned to or remained in the supine position for an extra 30 min. We evaluated oxygenation indices and histological lung injury scores, as well as TNF-α levels in BAL fluid and lung tissue.
Results:
After ALI induction, all of the animals showed significant hypoxemia, decreased respiratory system compliance, decreased oxygenation, and increased mean airway pressure in comparison with the baseline values. There were no statistically significant differences between the two groups, at any of the time points evaluated, in terms of the PaO2 or oxygenation index. However, TNF-α levels in BAL fluid were significantly lower in the PP group than in the SP group, as were histological lung injury scores.
Conclusions:
Prone positioning appears to attenuate inflammatory and histological lung injury during HFOV in rabbits with ALI.
... Prone ventilation is emerging as a promising adjuvant to lung-protective ventilatory strategies in ARDS in both the adult and pediatric populations. 1 There is a paucity of literature on the use of prone ventilation in pediatric cardiac surgery. By presenting this case series, the authors want to convey the efficacy of prone ventilation in infants with severe refractory hypoxemia after systemic infection and ARDS after complex congenital heart surgery. ...
... Clinically, some PFT outputs have been shown to be highly sensitive to position, particularly in patients with unilateral disease (Zack et al. 1974;Prokocimer et al. 1983;Gillespie and Rehder 1987). Equally, for some clinical practices, such as mechanical ventilation, there is disagreement over which position should be used (Thomas and Paratz 2007;Fessler and Talmor 2010), partially stemming from a lack of precision in prior studies of how gravity interacts with morphology in the context of disease. ...
... Beyond this, the results suggest the potential for clinical utility. In clinical literature there is disagreement over when different positions should be used to mechanically ventilate patients (Thomas and Paratz 2007;Fessler and Talmor 2010). The results in this study suggest that comparison of opposing position PFT outputs (or CT/ MR images) could be used to classify patient groups in a clinical setting, allowing for more targeted treatment protocols. ...
Multiple‐breath washout (MBW) is a pulmonary function test (PFT) that is used to infer lung function through measurement of ventilation heterogeneity (VH). However, the body position that a test is taken in may also influence VH, due to the “Slinky” effect of gravity on the lungs. In healthy subjects this has minimal effect, but in unhealthy groups, PFT outputs have been seen to change drastically with body position. In this study, we used a combined computational and clinical approach to better understand the response of outputs from the MBW to body position. A patient‐specific model of the MBW was developed, then validated against clinically measured washout data, as well as broader results in the literature. This model was then used to compare changes in MBW outputs with respect to body position, showing that output changes sensitively predict regional airway size differences between lobes. We then highlight cases in which body position effects may bias MBW outputs, leading to elevated or masked responses to bronchoconstriction. We close by placing this result in context with broader clinical practice, and showing how it can help improve interpretation of test outputs. A multiple‐breath washout model is developed which can accurately recreate patient‐specific data, as well as broader behavior seen in the literature. This model is used to investigate how body position can affect multiple‐breath washout (MBW) outputs. MBW outputs were seen to be signicantly affected by testing position, but in consistent and predictable ways. In patients with strong disease regionalization this may bias the test, causing the output to be exaggerated or masked.
... The result of the research shows that the prone position increases oxygen saturation and lowers inspiratory pressure unlike in the supination position, and that no difference is found in the respiratory rate in both positions 17 . Prone positioning has been widely administered as additional therapy for acute respiratory distress syndrome patients 18 . Semirecumbent positioning is an effective way to increase a patient's oxygenation status. ...
Objective:
Children with pneumonia need a correct position to increase their oxygen saturation and comfort level. Postural changes affect the function of the human body and disease conditions. This study aimed to identify the effect of prone and semirecumbent positions on the oxygen saturation and comfort level of children under five with pneumonia.
Method:
The study design was a quasi-experimental with a pre-posttest control group design. Thirty-six children with pneumonia aged 0-59 months were selected using consecutive sampling and divided into three groups: prone (n = 12), semirecumbent (n = 12), and control (n = 12). Statistical analysis was conducted using the Wilcoxon test, paired t test, and Kruskal-Wallis test.
Results:
A significant difference in the oxygen saturation level was found among the three groups, particularly in the semirecumbent group. No significant difference was observed on the comfort level in all groups.
Conclusions:
The semirecumbent position can be applied to improve the oxygenation status of children under five with pneumonia. Therefore, nurses should teach the family how to position the children with pneumonia during their hospitalization.
... Es así que los mecanismos, gracias a los cuales la posición en decúbito prono mejora la oxigenación, se basan en cambios en la distribución de la ventilaciónperfusión en las zonas dependientes pulmonares, así como en el efecto de la gravedad, liberación del peso del corazón, disminución de las presiones pulmonares y reducción en la respuesta infl amatoria que condiciona el VILI (lesión pulmonar inducida por el ventilador por su siglas en inglés). [10][11][12] La respuesta clínica a la ventilación en decúbito prono es valorada por la gasometría arterial, considerándose oxígeno-respondedores cuando el paciente presenta un incremento de al menos 20% en la relación PaO 2 / FiO 2 respecto a la inicial o incremento de ≥ 20 mmHg en la misma relación, o bien CO 2 -respondedores cuando presentan disminución de la PaCO 2 de al menos ≥ 1 mmHg. A su vez los respondedores pueden ser considerados persistentes o no persistentes de acuerdo con la PaO 2 al cambio a la posición supina. ...
Med Crit 2017;31(4):198-204 to admission to the ICU. (Fisher exact test with p > 0.05 and no signifi cant OR in all cases). Conclusions: Refractory hypoxemia is the most important factor involved with mortality in patients with severe ARDS. Mechanical ventilation in the prone position early and prolonged by 48 hours should be considered a standard practice in this patient group. RESUMO Introdução: A Síndrome da Angústia Respiratória Aguda (SARA), devido a doença pulmonar é atualmente uma condição que põe em risco a vida do paciente quando desenvolve hipoxemia grave e refratária, as estratégias terapêuticas são limitadas e até mesmo controversas. A ventilação mecânica em decúbito prono realizada mais cedo e prolongada está associada com aumento da sobrevida. Objetivo: Determinar a mortalidade associada com SARA grave por infl uenza usando como estratégia a ventilação mecânica em decúbito prono prolongada. Materiais e metodos: Estudo prospectivo, transversal, descritivo, de intervenção. Foram recrutados pacientes de março de 2016 a abril de 2016 com diagnóstico de SARA grave por infl uenza, que foram admitidos na unidade de terapia intensiva (UTI). Os pacientes foram agrupados de acordo com o resultado (melhora ou morte). Resultados: Foram incluídos 9 pacientes, com idade média de 47 ± 16 anos. 78% do sexo masculino. A comorbidade mais frequente foi a HAS com 44%. Durante a estância, oito pacientes foram submetidos a ventilação mecânica na posição decúbito prono e agrupados de acordo com o resultado. Três pacientes faleceram e seis tiveram alta da UTI por melhora. Não foi observada diferença significativa na idade, tempo de evolução, níveis de pH, PaO 2 , PaCO 2 , HCO3 ou SOFA na admissão em ambos os grupos (0 > 0.05 em todos os casos). 96 horas após a pronação os valores da PEEP foram maiores nos pacientes que faleceram (p = 0.026) e nos parâmetros da gasometria arterial observou-se uma diminuição nos níveis de O 2 e na relação PaO 2 /FiO 2 , ademais de um aumento nas necessidades FiO 2 nos pacientes que faleceram, sendo estatisticamente signifi cativa (p < 0.05). Outros fatores que foram analisados: antecedente de HAS, DM 2, tabagismo, tempo de pronação, tratamento com esteróides e uso de antibióticos prévia admissão na UTI. (Prova exata de Fisher com p > 0.05 e OR não signifi cativa em todos os casos). Conclusões: A hipoxemia refratária é o fator mais importante envolvido com a mortalidade em pacientes com infl uenza e SARA grave. A ventilação mecânica em decúbito prono precoce e prolongada por 48hrs deve ser considerado uma prática padrão neste grupo de pacientes. Palavras-chave: Ventilação em decúbito prono, hipoxemia grave, hipoxemia refratária, SARA. INTRODUCCIÓN Desde su primera descripción en la publicación de Ashbaugh 1 y cols. en 1967 hasta nuestros días, casi 50 años más tarde, la definición y descripción del síndrome de difi cultad respiratoria aguda (ARDS por sus siglas en inglés) han tenido importantes modifi-caciones. En aquella reseña de doce pacientes con insufi ciencia respiratoria aguda de diferente etiología, quienes tenían en común la presencia de infi ltrados alveolares difusos en la radiografía de tórax, disminu-ción en la distensibilidad pulmonar y notable mejoría con presión positiva al fi nal de la espiración (PEEP), se hizo hincapié en los hallazgos de la necropsia, en la cual la formación de membranas hialinas, trombosis de los vasos sanguíneos, hiperemia, engrosamiento de capilares y áreas de colapso alveolar fueron parte RESUMEN Introducción: El síndrome de difi cultad respiratoria aguda (SIRA) de causa pulmonar es actualmente una condición que pone en peligro la vida del paciente cuando se desarrolla hipoxemia severa y refractaria. Las estrategias terapéuti-cas son limitadas e incluso controversiales. La ventilación mecánica en decúbito prono llevada a cabo de manera temprana y prolongada se asocia a incremento en la sobrevida. Objetivos: Determinar la mortalidad asociada al SIRA severo por infl uenza uti-lizando como estrategia la ventilación mecánica en decúbito prono prolongada. Materiales y métodos: Estudio prospectivo, transversal, descriptivo y de inter-vención. Se reclutaron pacientes de marzo de 2016 a abril de 2016 con diag-nóstico de SIRA severo por infl uenza que ingresaron a la Unidad de Cuidados Intensivos (UCI). Se agrupó a los pacientes de acuerdo con el desenlace (me-joría o defunción). Resultados: Se incluyeron nueve pacientes con una media de edad de 47 ± 16 años. En 78% fueron hombres. La comorbilidad más frecuente fue la HAS con 44%. Ocho pacientes fueron sometidos durante su estancia a ventilación mecánica en decúbito prono y se agruparon según el desenlace. Tres pacientes fallecieron y seis fueron dados de alta de la UCI por mejoría. No se obser-vó diferencia signifi cativa en edad, tiempo de evolución, niveles de pH, PaO 2 , PaCO 2 , HCO 3 , o SOFA a su ingreso en ambos grupos (p > 0.05 en todos los casos). Después de 96 horas de la pronación los valores de la PEEP fueron más altos en los pacientes fallecidos (p = 0.026) y en los parámetros de ga-sometría arterial se detectó disminución en los niveles O 2 y la relación PaO 2 / FiO 2 , además de aumento en los requerimientos de FiO 2 en los pacientes que fallecieron, siendo estadísticamente signifi cativo (p < 0.05). Otros factores que se analizaron fueron antecedente de HAS, DM 2, tabaquismo, tiempo de pro-nación, manejo con esteroide y uso de antibióticos previo al ingreso a la UCI. (Prueba exacta de Fisher con p > 0.05 y OR no signifi cativa en todos los casos). Conclusiones: La hipoxemia refractaria es el factor más importante involucra-do en la mortalidad en pacientes con infl uenza y SIRA severo. La ventilación mecánica en decúbito prono temprana y prolongada por 48 horas debería con-siderarse una práctica habitual en este grupo de pacientes. Palabras clave: Ventilación en decúbito prono, hipoxemia severa, hipoxemia refractaria, SIRA. SUMMARY Background: Acute respiratory distress syndrome (ARDS) due to pulmonary disease is currently a condition that endangers the patient's life, when severe and refractory hypoxemia develops, therapeutic strategies are limited and even controversial. Mechanical ventilation in prone position conducted early and prolonged is associated with increased survival. Objetives: To determine the mortality associated with severe ARDS by infl uenza using a strategy of prolonged mechanical ventilation in prone position. Materials and Methods: A prospective, cross-sectional, descriptive study intervention. March 2016 patients were recruited to April 2016 with the diagnosis of severe ARDS, which will enter the Intensive Care Unit (ICU). They were grouped patients according to outcome (improvement or death). Results: Nine patients were included, with a mean age of 47 ± 16 years. 78% were men. The most frequent comorbidity was hypertension with 44%. During their stay, eight patients underwent mechanical ventilation in prone position and were grouped according to the outcome. Three patients died and six were discharged from the ICU for improvement. No signifi cant difference was observed in age, duration, pH levels, PaO 2 , PaCO 2 , HCO 3 or SOFA at admission in both groups (p > 0.05 in all cases). Ninety six hours after pronation values PEEP were higher in patients who died (p = 0.026) and parameters ABG decrease in O 2 levels and PaO 2 /FiO 2 was observed, in addition to increase in FiO 2 requirements in the patient who died, were statistically signifi cant (p < 0.05). Other factors that were analyzed were history of hypertension, diabetes mellitus, smoking, time pronation, handling and use of steroid antibiotics prior Ventilación mecánica en decúbito prono: estrategia ventilatoria temprana y prolongada en SIRA severo por influenza Este artículo puede ser consultado en versión completa en
... Es así que los mecanismos, gracias a los cuales la posición en decúbito prono mejora la oxigenación, se basan en cambios en la distribución de la ventilaciónperfusión en las zonas dependientes pulmonares, así como en el efecto de la gravedad, liberación del peso del corazón, disminución de las presiones pulmonares y reducción en la respuesta infl amatoria que condiciona el VILI (lesión pulmonar inducida por el ventilador por su siglas en inglés). [10][11][12] La respuesta clínica a la ventilación en decúbito prono es valorada por la gasometría arterial, considerándose oxígeno-respondedores cuando el paciente presenta un incremento de al menos 20% en la relación PaO 2 / FiO 2 respecto a la inicial o incremento de ≥ 20 mmHg en la misma relación, o bien CO 2 -respondedores cuando presentan disminución de la PaCO 2 de al menos ≥ 1 mmHg. A su vez los respondedores pueden ser considerados persistentes o no persistentes de acuerdo con la PaO 2 al cambio a la posición supina. ...
Background: Acute respiratory distress syndrome (ARDS) due to pulmonary disease is currently a condition that endangers the patient’s life, when severe and refractory hypoxemia develops, therapeutic strategies are limited and even controversial. Mechanical ventilation in prone position conducted early and prolonged is associated with increased survival. Objetives: To determine the mortality associated with severe ARDS by influenza using a strategy of prolonged mechanical ventilation in prone position. Materials and Methods: A prospective, cross-sectional, descriptive study intervention. March 2016 patients were recruited to April 2016 with the diagnosis of severe ARDS, which will enter the Intensive Care Unit (ICU). They were grouped patients according to outcome (improvement or death). Results: Nine patients were included, with a mean age of 47 ± 16 years. 78% were men. The most frequent comorbidity was hypertension with 44%. During their stay, eight patients underwent mechanical ventilation in prone position and were grouped according to the outcome. Three patients died and six were discharged from the ICU for improvement. No significant difference was observed in age, duration, pH levels, PaO2, PaCO2, HCO3 or SOFA at admission in both groups (p > 0.05 in all cases). Ninety six hours after pronation values PEEP were higher in patients who died (p = 0.026) and parameters ABG decrease in O2 levels and PaO2/FiO2 was observed, in addition to increase in FiO2 requirements in the patient who died, were statistically significant (p < 0.05). Other factors that were analyzed were history of hypertension, diabetes mellitus, smoking, time pronation, handling and use of steroid antibiotics prior to admission to the ICU. (Fisher exact test with p > 0.05 and no significant OR in all cases). Conclusions: Refractory hypoxemia is the most important factor involved with mortality in patients with severe ARDS. Mechanical ventilation in the prone position early and prolonged by 48 hours should be considered a standard practice in this patient group.
... A su vez, una relación V/Q más homogénea impacta positivamente sobre la oxigenación. 8,9 El uso del DP tiene un sustento bibliográfico sumamente firme. Varios ensayos clínicos aleatorizados y controlados (ECAC) han demostrado el efecto del DP sobre la oxigenación en pacientes con SDRA medida a través de la relación PaO 2 /FiO 2 10,11 e incluso su impacto en prolongar la supervivencia. ...
Los autores no declaran conflictos de intereses. Resumen Los pacientes con síndrome de distrés respiratorio agudo demandan gran atención en la Unidad de Cuidados Intensivos. La utilización del decúbito prono en esta población tiene un sustento bibliográfico sumamente sólido y, en varios ensayos clínicos aleatorizados, se ha comprobado su efecto sobre la oxigenación medida a través de la relación PaO 2 /FiO 2 e incluso su impacto en prolongar la supervivencia. Esta estrategia ha demostrado ser una maniobra útil y accesible para la mayor parte de las Unidades de Cuidados Intensivos y su implementación, realizada de manera protocolizada y por personal en-trenado, debería ser considerada en un grupo selecto de pacientes quienes se beneficiarían en términos de mortalidad. En la Argentina, pareciera que muchos profesionales han decidido implementar la maniobra en sus lugares de trabajo, con un bajo porcentaje de complicaciones. Abstract Patients with acute respiratory distress syndrome demand great attention in the Intensive Care Unit. The use of prone position in this population has a very robust literary support, and several randomized clinical trials have shown the effect on oxygenation (represented by an increase in PaO 2 /FiO 2) and even its impact on increasing survival. The prone position has proved to be a useful and accessible maneuver for most of Intensive Care Units and its implementation , following a protocol and done for trained personnel, should be considered in a select group of patients who would benefit in terms of mortality. In Argentina, many professionals have decided to implement the prone position in their workplace, with a low percentage of complications. Palabras clave ■ Decúbito prono ■ Síndrome de distrés respiratorio agudo ■ Hipoxemia refractaria ■ Unidad de Cuidados Intensivos
... Varios estudios experimentales han mostrado que la posición DP disminuye el gradiente de presión pleural, conllevando que la presión pleural de las áreas dorsales sea más negativa 130,133 , lo cual incrementa la presión transpulmonar, superando la presión de cierre alveolar, esto mantiene abierto el alveolo (reclutado). Por otra parte, la presión pleural en las áreas ventrales en esta posición es menos negativa, disminuyendo la presión transpulmonar, pero manteniéndose por encima de la presión de cierre alveolar, lo cual conlleva que permanezcan ventiladas 134 . ...
The Acute Respiratory Distress Syndrome involves a complex series of events leading to alveolar damage, pulmonary edema due to increased vascular permeability and respiratory failure; many processes are related to its appearance, the common feature is the activation of neutrophils in the pulmonary or systemic circulation. Clinical manifestations usually appear 6 to 72 hours after the event start the event and get worse quickly. The treatment is based on an interdisciplinary handling by the staff of the intensive care unit, making an early recognition of patients ruling out other causes of hypoxemia, identifying and treating the underlying cause, and using mechanical ventilation to ensure proper oxygenation and ventilation, always trying to protect the lungs from mechanical ventilation induced lung injury. Prone position ventilation promotes increased oxygenation in patients with this syndrome, the mechanisms that cause this increase are probably multiple and interdependent and have not been fully elucidated. It is a low-cost procedure, recommended in patient in serious category, and preferably in early stage of the disease. Future studies are needed that can establish the real impact on mortality to assess their systematic use in all patients with Acute Respiratory Distiess Syndrome. MÉD.UIS. 2016;29(2):81-101.
