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Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome

Richard, Jean-Christophe M. ; Maggiore, Salvatore Maurizio ; Mancebo, Jordi ; Lemaire, Francois ; Jonson, Björn LU and Brochard, Laurent (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)
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author
; ; ; ; and
organization
publishing date
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
2020-11-10 05:03:14
@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},
  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},
}