Prone position and recruitment manoeuvre: the combined effect improves oxygenation

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Mechanical Ventilation

Background:

• Acute Respiratory Distress Syndrome (ARDS) presents significant oxygenation challenges.
• Ventilation-induced lung injury is a major concern in ARDS management.
• Prone positioning (PP) and recruitment maneuvers (RMs) are strategies to improve oxygenation and reduce lung injury.

Purpose of the Study:

• To evaluate the effects of combining prone positioning (PP) and recruitment maneuvers (RMs) on oxygenation in early ARDS patients.
• To assess the impact of RMs at different time points during PP on oxygenation.
• To determine if this combined ventilation strategy offers durable benefits.

Main Methods:

• Prospective study of 16 early ARDS patients.
• Patients underwent ventilation in supine position (SP) and prone position (PP) for six hours each.
• Recruitment maneuvers (45 cmH2O extended sigh) were performed at the start of SP, after 1 hour in PP, and at the end of PP.

Main Results:

• Recruitment maneuvers led to progressive increases in PaO2, with significant improvement after the third maneuver (RM3).
• Oxygenation improvements were transient in SP but durable during PP.
• The combined strategy increased the PaO2/FiO2 ratio from 98.3 mmHg to 165.6 mmHg by the study's end.
• Plateau airway pressures decreased significantly after RM3.
• Transient blood pressure variations were noted as a side effect.

Conclusions:

• A 45 cmH2O extended sigh during prone positioning significantly improves oxygenation in ARDS.
• The combination of recruitment maneuvers and prone positioning yields the highest increase in PaO2/FiO2 ratio.
• This combined ventilation strategy demonstrates efficacy with no major clinical side effects.