Robak O, Schellongowski P, Bojic A, Laczika K, Locker GJ, Staudinger T.; Crit Care. 2011 Sep 29;15(5):R230. [Epub ahead of print]
INTRODUCTION: Prone position is known to improve oxygenation in patients with Acute Lung Injury (ALI) and the Acute Respiratory Distress Syndrome (ARDS). Supine upright (semi-recumbent) position also exerts beneficial effects on gas exchange in this group of patients. To evaluate the effect of combining upright and prone position on oxygenation and respiratory mechanics in patients suffering from ALI or ARDS in a prospective randomized cross-over study.
METHODS: After turning them prone from supine position, patients were randomized to prone position or combined prone and upright position. After two hours the position was changed to the other one for another six hours, respectively. Gas exchange and static compliance of respiratory system, lungs and chest wall were assessed in supine position as well as every hour in prone position.
RESULTS: Twenty patients were enrolled into the study. PaO^2/FiO^2 – ratio improved significantly from supine to prone position and further significantly increased with additional upright position. Fourteen patients (70%) were classified as responders to prone position, while 17 patients (85%) responded to prone plus upright position compared to supine position (p=n.s.). There were no statistically significant changes with respect to compliance.
CONCLUSIONS: Combining prone position with upright position in patients with ALI or ARDS leads to further improvement of oxygenation.
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