[Artifical respiration with patient in prone position]

Area of Science:

• Critical Care Medicine
• Respiratory Physiology

Background:

• Mechanical ventilation in the prone position has been studied for two decades to understand its oxygenation benefits in Acute Respiratory Distress Syndrome (ARDS).
• In supine patients, lung perfusion is highest dorsally, while prone positioning preserves this perfusion and resolves dorsal atelectasis.

Purpose of the Study:

• To investigate the mechanism of improved oxygenation in ARDS patients placed in the prone position.
• To establish recommendations for the use of prone positioning in managing ARDS.

Main Methods:

• Review of investigations into the physiological effects of prone positioning on ARDS patients.
• Analysis of ventilation/perfusion ratio changes in supine versus prone positions.

Main Results:

• Prone positioning improves the ventilation/perfusion ratio in ARDS patients.
• Sixty-five percent of early ARDS patients experience significant oxygenation improvement when placed prone.
• Prone positioning can be repeated daily if effective.

Conclusions:

• Prone positioning is an effective intervention for improving oxygenation in early ARDS patients with persistent hypoxia.
• Recommended for patients on mechanical ventilation with PEEP and high FiO2 (above 60%) who remain hypoxic.
• Further research is needed for its effects in other acute lung failure types.