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. 2024 Dec;38(6):1425-1429.
doi: 10.1007/s10877-024-01182-x. Epub 2024 Jul 27.

Prone-position decreases airway closure in a patient with ARDS undergoing venovenous extracorporeal membrane oxygenation

Marco Giani  1   2 , Andrea Restivo  1 , Davide Raimondi Cominesi  1 , Rosa Fracchia  1   2 , Matteo Pozzi  1   2 , Lorenzo Del Sorbo  3   4   5 , Giuseppe Foti  1   2 , Laurent Brochard  3   6 , Emanuele Rezoagli  7   8
Affiliations

Prone-position decreases airway closure in a patient with ARDS undergoing venovenous extracorporeal membrane oxygenation

Marco Giani et al. J Clin Monit Comput. 2024 Dec.

Abstract

Purpose: Airway closure is a interruption of communication between larger and smaller airways. The presence of airway closure during mechanical ventilation may lead to the overestimation of driving pressure (DP), introducing errors in the assessment of respiratory mechanics and in positive end-expiratory pressure (PEEP) setting on the ventilator. Patients with severe acute respiratory distress syndrome (ARDS) may exhibit the airway closure phenomenon, which can be easily diagnosed with a low-flow inflation. Prone positioning is a therapeutic manoeuver proven to reduce mortality in ARDS patients, and has been widely implemented also in patients requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO). To date, the impact of prone positioning on changes in airway closure has not been described.

Methods: We present an image analysis of the pressure waveform during volume-controlled ventilation and low-flow inflations before and after prone positioning in an ARDS patient on VV ECMO.

Results: A high airway opening pressure level (23 cmH2O) was detected in the supine position during tidal ventilation. Airway closure was confirmed by using a low-flow inflation. Prone positioning significantly attenuated airway closure, with the airway opening pressure decreasing to 13 cmH2O. After re-supination, airway closure was lower as compared with supine position at baseline (17 cmH2O).

Conclusion: Prone positioning reduced airway closure in an ARDS patient on VV ECMO support.

Keywords: Acute respiratory distress syndrome; Airway closure; Driving pressure; Prone position; Respiratory mechanics; Veno-venous extracorporeal membrane oxygenation.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

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