• Rudolf Hering, Ralph Vorwerk, Hermann Wrigge, Jörg Zinserling, Stefan Schröder, Tilman von Spiegel, Andreas Hoeft, and Christian Putensen.
• Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. hering@uni-bonn.de
• Intensive Care Med. 2002 Jan 1;28(1):53-8.

ObjectiveTo investigate the effects of prone positioning on systemic hemodynamics, intra-abdominal pressure (IAP), plasma disappearance rate of indocyanine green (PDR(ICG)), and gastric intramucosal to arterial PCO2 difference (Pi-aCO2).Design And SettingProspective randomized study in the intensive care unit of a university hospital.Patients12 mechanically ventilated, hemodynamically stable patients with acute lung injury.InterventionPositioning supine and prone for 3 h in random order.MeasurementsSystemic hemodynamics were determined by transpulmonary double-indicator dilution technique using an integrating fiberoptic monitoring system. The same monitoring system was used to measure PDR(ICG). IAP was measured in the urinary bladder and gastric intramucosal PCO2 was evaluated by automated recirculation gas tonometry.ResultsIAP increased from 10 +/-3 in the supine to 13+/-4 mmHg in the prone position. Cardiac index increased from 3.8+/-0.9 (supine) to 4.2+/-0.6 l/m(2) per minute (prone), mean arterial pressure from 75+/-10 (supine) to 81+/-11 mmHg (prone), PaO2/FIO2 from 194+/-66 (supine) to 269+/-68 mmHg (prone), and oxygen delivery from 558+/-122 (supine) to 620+/-74 ml/m(2) per minute (prone). No other parameters, including PDR(ICG) and Pi-aCO2, differed between the two positions.ConclusionsProne positioning in mechanically ventilated patients with acute lung injury, despite a small increase in IAP, does not negatively affect the hepatic capacity to eliminate ICG and gastric intramucosal energy balance when systemic blood flow and oxygenation are improved.

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