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

Autor: Giani M; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.; Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy., Restivo A; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy., Raimondi Cominesi D; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy., Fracchia R; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.; Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy., Pozzi M; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.; Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy., Del Sorbo L; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.; Department of Medicine, Division of Respirology, University Health Network/Sinai Health System, University of Toronto, Toronto, Canada.; Toronto General Hospital, Toronto, Canada., Foti G; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.; Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy., Brochard L; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Canada., Rezoagli E; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. emanuele.rezoagli@unimib.it.; Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy. emanuele.rezoagli@unimib.it.
Jazyk: angličtina
Zdroj: Journal of clinical monitoring and computing [J Clin Monit Comput] 2024 Dec; Vol. 38 (6), pp. 1425-1429. Date of Electronic Publication: 2024 Jul 27.
DOI: 10.1007/s10877-024-01182-x
Abstrakt: 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 cmH 2 O) 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 cmH 2 O. After re-supination, airway closure was lower as compared with supine position at baseline (17 cmH 2 O).
Conclusion: Prone positioning reduced airway closure in an ARDS patient on VV ECMO support.
Competing Interests: Declarations. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)
Databáze: MEDLINE
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