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Prone Position Minimizes the Exacerbation of Effort-dependent Lung Injury: Exploring the Mechanism in Pigs and
Takeshi Yoshida1, Doreen Engelberts2, Han Chen3
1Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Anesthesiology
|March 18, 2022
Summary
The prone position reduces lung stress and injury caused by spontaneous breathing efforts in patients with acute respiratory distress syndrome. This positioning helps to equalize pressure distribution and lessen lung damage.
Area of Science:
- Respiratory Physiology
- Critical Care Medicine
- Pulmonary Injury Research
Background:
- Vigorous spontaneous breathing efforts can exacerbate lung injury.
- The prone position is explored as an intervention to mitigate this effect.
Purpose of the Study:
- To investigate if the prone position reduces lung stress and inflation maldistribution during diaphragmatic contraction.
- To determine if the prone position decreases spontaneous effort and subsequent lung injury.
Main Methods:
- Acute respiratory distress syndrome models were created in pigs and rabbits.
- Lung mechanics (pleural pressure, inflation) and injury markers were assessed in supine and prone positions under varying positive end-expiratory pressure levels.
Main Results:
- The prone position eliminated ventral-to-dorsal pressure gradients and achieved homogeneous lung inflation, irrespective of positive end-expiratory pressure.
- In the supine position, spontaneous effort caused significant dorsal overinflation and increased lung injury, which was reduced but not eliminated by higher positive end-expiratory pressure.
- The prone position resulted in milder spontaneous effort and less regional lung injury compared to the supine position.
Conclusions:
- The prone position effectively reduces lung stress and inflation maldistribution caused by spontaneous effort.
- Prone positioning mitigates spontaneous effort-induced lung injury, independent of positive end-expiratory pressure levels.
