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 PaO(2) 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+/-9 1ml in nonresponders); this change was correlated to oxygenation change (rho=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.
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 PaO(2) 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+/-9 1ml in nonresponders); this change was correlated to oxygenation change (rho=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 ARDSpatients.
Authors: Erica Messerole; Pam Peine; Sue Wittkopp; John J Marini; Richard K Albert Journal: Am J Respir Crit Care Med Date: 2002-05-15 Impact factor: 21.405
Authors: C Klingstedt; G Hedenstierna; S Baehrendtz; H Lundqvist; A Strandberg; L Tokics; B Brismar Journal: Acta Anaesthesiol Scand Date: 1990-08 Impact factor: 2.105
Authors: C Klingstedt; G Hedenstierna; H Lundquist; A Strandberg; L Tokics; B Brismar Journal: Acta Anaesthesiol Scand Date: 1990-05 Impact factor: 2.105
Authors: N Deye; F Lellouche; S M Maggiore; S Taillé; A Demoule; E L'Her; F Galia; A Harf; J Mancebo; L Brochard Journal: Intensive Care Med Date: 2012-10-24 Impact factor: 17.440
Authors: Matthew W Semler; David R Janz; Derek W Russell; Jonathan D Casey; Robert J Lentz; Aline N Zouk; Bennett P deBoisblanc; Jairo I Santanilla; Yasin A Khan; Aaron M Joffe; William S Stigler; Todd W Rice Journal: Chest Date: 2017-05-06 Impact factor: 9.410
Authors: John Selickman; Philip S Crooke; Pierre Tawfik; David J Dries; Luciano Gattinoni; John J Marini Journal: Crit Care Med Date: 2022-07-21 Impact factor: 9.296
Authors: J Dellamonica; N Lerolle; C Sargentini; S Hubert; G Beduneau; F Di Marco; A Mercat; J L Diehl; J C M Richard; G Bernardin; L Brochard Journal: Intensive Care Med Date: 2013-01-24 Impact factor: 17.440
Authors: Oliver Robak; Peter Schellongowski; Andja Bojic; Klaus Laczika; Gottfried J Locker; Thomas Staudinger Journal: Crit Care Date: 2011-09-29 Impact factor: 9.097
Authors: Ivan Göcze; Felix Strenge; Florian Zeman; Marcus Creutzenberg; Bernhard M Graf; Hans J Schlitt; Thomas Bein Journal: Crit Care Date: 2013-04-26 Impact factor: 9.097