Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome
(2006) In Intensive Care Medicine 32(10). p.1623-1626- Abstract
- Objective: Supine position may contribute to the loss of aerated lung volume in patients with acute respiratory distress syndrome (ARDS). We hypothesized that verticalization increases lung volume and improves gas exchange by reducing the pressure surrounding lung bases. Design and setting: Prospective observational physiological study in a medical ICU. Subjects and intervention: In 16 patients with ARDS we measured arterial blood gases, pressure-volume curves of the respiratory system recorded from positive-end expiratory pressure (PEEP), and changes in lung volume in supine and vertical positions (trunk elevated at 45 degrees and legs down at 45 degrees). Measurements and results: Vertical positioning increased PaO2 significantly from 94... (More)
- Objective: Supine position may contribute to the loss of aerated lung volume in patients with acute respiratory distress syndrome (ARDS). We hypothesized that verticalization increases lung volume and improves gas exchange by reducing the pressure surrounding lung bases. Design and setting: Prospective observational physiological study in a medical ICU. Subjects and intervention: In 16 patients with ARDS we measured arterial blood gases, pressure-volume curves of the respiratory system recorded from positive-end expiratory pressure (PEEP), and changes in lung volume in supine and vertical positions (trunk elevated at 45 degrees and legs down at 45 degrees). Measurements and results: Vertical positioning increased PaO2 significantly from 94 +/- 33 to 142 +/- 49 mmHg, with an increase higher than 40% in 11 responders. The volume at 20 cmH(2)O measured on the PV curve from PEEP increased using the vertical position only in responders (233 +/- 146 vs. -8 +/- 91 ml in nonresponders); this change was correlated to oxygenation change (p = 0.55). End-expiratory lung volume variation from supine to vertical and 1 h later back to supine, measured in 12 patients showed a significant increase during the 1-h upright period in responders (n =7) but not in nonresponders (n = 5; 215 +/- 220 vs. 10 +/- 22 ml), suggesting a time-dependent recruitment. Conclusions: Vertical positioning is a simple technique that may improve oxygenation and lung recruitment in ARDS patients. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/389596
- author
- Richard, Jean-Christophe M. ; Maggiore, Salvatore Maurizio ; Mancebo, Jordi ; Lemaire, Francois ; Jonson, Björn LU and Brochard, Laurent
- organization
- publishing date
- 2006
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- gas exchange, lung volume, recruitment, positioning, acute respiratory distress syndrome, mechanical ventilation
- in
- Intensive Care Medicine
- volume
- 32
- issue
- 10
- pages
- 1623 - 1626
- publisher
- Springer
- external identifiers
-
- wos:000240911500025
- scopus:33749262498
- pmid:16896856
- ISSN
- 0342-4642
- DOI
- 10.1007/s00134-006-0299-y
- language
- English
- LU publication?
- yes
- id
- 5c3a01fb-db71-4d26-8a15-acf7c7f5dfaa (old id 389596)
- date added to LUP
- 2016-04-01 12:04:41
- date last changed
- 2022-04-21 02:09:16
@article{5c3a01fb-db71-4d26-8a15-acf7c7f5dfaa,
abstract = {{Objective: Supine position may contribute to the loss of aerated lung volume in patients with acute respiratory distress syndrome (ARDS). We hypothesized that verticalization increases lung volume and improves gas exchange by reducing the pressure surrounding lung bases. Design and setting: Prospective observational physiological study in a medical ICU. Subjects and intervention: In 16 patients with ARDS we measured arterial blood gases, pressure-volume curves of the respiratory system recorded from positive-end expiratory pressure (PEEP), and changes in lung volume in supine and vertical positions (trunk elevated at 45 degrees and legs down at 45 degrees). Measurements and results: Vertical positioning increased PaO2 significantly from 94 +/- 33 to 142 +/- 49 mmHg, with an increase higher than 40% in 11 responders. The volume at 20 cmH(2)O measured on the PV curve from PEEP increased using the vertical position only in responders (233 +/- 146 vs. -8 +/- 91 ml in nonresponders); this change was correlated to oxygenation change (p = 0.55). End-expiratory lung volume variation from supine to vertical and 1 h later back to supine, measured in 12 patients showed a significant increase during the 1-h upright period in responders (n =7) but not in nonresponders (n = 5; 215 +/- 220 vs. 10 +/- 22 ml), suggesting a time-dependent recruitment. Conclusions: Vertical positioning is a simple technique that may improve oxygenation and lung recruitment in ARDS patients.}},
author = {{Richard, Jean-Christophe M. and Maggiore, Salvatore Maurizio and Mancebo, Jordi and Lemaire, Francois and Jonson, Björn and Brochard, Laurent}},
issn = {{0342-4642}},
keywords = {{gas exchange; lung volume; recruitment; positioning; acute respiratory distress syndrome; mechanical ventilation}},
language = {{eng}},
number = {{10}},
pages = {{1623--1626}},
publisher = {{Springer}},
series = {{Intensive Care Medicine}},
title = {{Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome}},
url = {{http://dx.doi.org/10.1007/s00134-006-0299-y}},
doi = {{10.1007/s00134-006-0299-y}},
volume = {{32}},
year = {{2006}},
}