Ugeskrift for laeger
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The use of mechanical ventilation in prone position was proposed 20 years ago. Since then several investigations have been made trying to explain the mechanism whereby oxygenation is improved when the patient with ARDS is turned into the prone position. In supine position the lung perfusion is highest in the dorsal regions in normal healthy persons. ⋯ It is recommended that patients with early ARDS that remain hypoxic on mechanical ventilation with PEEP and inspiratory oxygen concentration above 60% be turned prone for 3-6 hours. If effective, the treatment can be repeated once or twice daily until regression of hypoxia. The possible effects of the prone position in other types of acute lung failure are so far not known.
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Ugeskrift for laeger · Aug 1998
Case Reports[Patients with acute respiratory distress syndrome mechanically ventilated in prone position].
Animal experiments and human studies have shown better oxygenation in mechanically ventilated patients with ARDS when the patient is situated in the prone position. In contradiction to former theories of a gravitational gradient of lung perfusion, a number of investigators have found that lung perfusion is preferentially distributed to the dorsal lung regions regardless of body position. ⋯ In two cases of prone position in mechanically ventilated patients the PaO2/FiO2 ratio increased from 7.5 to 14.3 and from 8.8 to 19.8 after one hour in the prone position, and some of the improvement was permanent. Prone position has only minor side effects and is recommended as the first choice amongst adjunct therapies in mechanical ventilation in patients with ARDS remaining hypoxic in conventional therapy in the supine position.