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. 2011;15(3):R125.
doi: 10.1186/cc10235. Epub 2011 May 16.

Prone position and recruitment manoeuvre: the combined effect improves oxygenation

Gilles Rival  1 , Cyrille Patry, Nathalie Floret, Jean Christophe Navellou, Evelyne Belle, Gilles Capellier
Affiliations

Prone position and recruitment manoeuvre: the combined effect improves oxygenation

Gilles Rival et al. Crit Care. 2011.

Abstract

Introduction: Among the various methods for improving oxygenation while decreasing the risk of ventilation-induced lung injury in patients with acute respiratory distress syndrome (ARDS), a ventilation strategy combining prone position (PP) and recruitment manoeuvres (RMs) can be practiced. We studied the effects on oxygenation of both RM and PP applied in early ARDS patients.

Methods: We conducted a prospective study. Sixteen consecutive patients with early ARDS fulfilling our criteria (ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO2/FiO2) 98.3 ± 28 mmHg; positive end expiratory pressure, 10.7 ± 2.8 cmH2O) were analysed. Each patient was ventilated in both the supine position (SP) and the PP (six hours in each position). A 45 cmH2O extended sigh in pressure control mode was performed at the beginning of SP (RM1), one hour after turning to the PP (RM2) and at the end of the six-hour PP period (RM3).

Results: The mean arterial oxygen partial pressure (PaO2) changes after RM1, RM2 and RM3 were 9.6%, 15% and 19%, respectively. The PaO2 improvement after a single RM was significant after RM3 only (P < 0.05). Improvements in PaO2 level and PaO2/FiO2 ratio were transient in SP but durable during PP. PaO2/FiO2 ratio peaked at 218 mmHg after RM3. PaO2/FiO2 changes were significant only after RM3 and in the pulmonary ARDS group (P = 0.008). This global strategy had a benefit with regard to oxygenation: PaO2/FiO2 ratio increased from 98.3 mmHg to 165.6 mmHg 13 hours later at the end of the study (P < 0.05). Plateau airway pressures decreased after each RM and over the entire PP period and significantly after RM3 (P = 0.02). Some reversible side effects such as significant blood arterial pressure variations were found when extended sighs were performed.

Conclusions: In our study, interventions such as a 45 cmH2O extended sigh during PP resulted in marked oxygenation improvement. Combined RM and PP led to the highest increase in PaO2/FiO2 ratio without major clinical side effects.

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Figures

Figure 1
Figure 1
Recruitment maneuver in pressure control mode ventilation.
Figure 2
Figure 2
Study design. RM, recruitment manoeuvre; PEEP, positive end expiratory pressure, PIP, peak inspiratory pressure.
Figure 3
Figure 3
Changes in mean arterial pressure (MAP) during the three recruitment maneuvers showing significant decrease in MAP. RM1: P = 0.008; RM2: P = 0.03; RM3: P = 0.01.
See this image and copyright information in PMC

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