| Abstrakt: |
To evaluate alterations in pulmonary function with positioning, 9 intubated neonates (wt. [mean] 2.3 kg., gest. age 34 wks., FiO2.29, CPAP or PEEP 4 cm H2O) were studied in 4 positions (SC= supine control, PR=prone-abdomen restricted, PF=prone-abdomen hanging free, SF=supine followup). After 30 min. in each position; arterial blood gases, lung mechanics, and funct. residual cap. (FRC) were measured. Mean values in supine control were: pO267 torr, pC0242 torr, RR 54 breaths/min., lung compliance (CL) 1.7 ml/cm H2O, tidal volume (VT) 4.15 cc/kg, minute ventilation (VE) 263 ml/kg/min, FRC 26 ml/kg. In PR compared to SC: pO2increased 12 torr (mean); FRC decreased 15%. In the PF compared to SC: pO2increased 15 torr, mean FRC was unchanged but increased in 5/8 pts. In PF compared to PR: pO2increased 6 torr; mean FRC was unchanged but increased in 5/7 pts. All comparisons of CL, pCO2, VE between the above groups were unchanged. In SF compared to PF: pO2decreased 9 torr, FRC decreased 27%, CL decreased 44%, pCO2was unchanged, VE decreased 20%. Summary of trends: 1) compared to supine control pO2increased in both prone positions and FRC decreased in prone-abdomen restricted; 2) PF was better of 2 prone positions for increasing FRC. This study demonstrates that prone positioning improves oxygenation in neonates and that the prone-abdomen free is the best prone position for increasing lung volumes in infants with respiratory disease. |
