Effects of Prone and Semi-recumbent Position on Abdominal Pressure, Hemodynamics, and Alveolar Oxygenation in Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) Patients
Şenay Göksu1, Asu Özgültekin21Department of Anaestehesiology and Reanimation, University of Health Sciences Türkiye, Umraniye Training and Research Hospital, Istanbul, Türkiye2Department of Anaestehesiology and Reanimation, University of Health Sciences Türkiye, Haydarpasa Numune Training and Research Hospital, Istanbul Türkiye
INTRODUCTION: Although intra-abdominal pressure (IAP) increases during prone and semi-recumbent positions, these positions are included in the treatment protocols for patients with Acute Lung Injury (ALI) and Adult Acute Respiratory Distress Syndrome (ARDS).
The aim of the study was to determine the effects of prone and semi-recumbent positions on hemodynamic, ventilatory, and blood gas parameters by IAP elevation.
METHODS: After ethics committee approval, the patients (aged 18-60 years) diagnosed with ALI-ARDS according to the American-European consensus were enrolled. Hemodynamic and IAP monitoring were performed with central venous and femoral artery and urinary catheters.
Patients were intubated and mechanically ventilated. Ventilatory mode (adjusted based on blood gas analyses), sedation, and feeding protocols were the same. SOFA, LIS, and APACHE II scores, CVP, IAP, Ppeak, Pmean, VTe, Cdyn, HR, MAP, CI, EVLWI (Pulsion PiCCO), pH, PaCO2, and PaO2/FiO2 were measured. Measurement time points: T1 (baseline-supine position), T2, T3 (prone position, 60., 120. minute), T4, T5 (semi-recumbent position, 60., 120. minute).
RESULTS: The study was performed in 15 patients without abdominal support. Oxygenation and IAP were significantly increased in all positions. A significant increase in oxygenation was detected by decreasing EVLWI at T3. A significant decrease in PaCO2 was observed by increasing VTe at T2 and T3, in heart rate at T3, in MAP at T2, and in CI at T4, without any hemodynamic deterioration.
DISCUSSION AND CONCLUSION: Prone and semi-recumbent positions could be used in ARDS to improve oxygenation without unfavorable hemodynamic effects. Our study may provide a protocol for larger studies evaluating prolonged prone and semi-recumbent positions.
Manuscript Language: English