EFFECTS OF VENTILATION IN VENTRAL DECUBITUS POSITION ON RESPIRATORY MECHANICS IN ADULT-RESPIRATORY-DISTRESS-SYNDROME

Objective: To assess the potential benefits of a period of ventilation in ventral decubitus (VD) on oxygenation and respiratory mechanics in the adult respiratory distress syndrome (ARDS). Design: In a stable c ondition during baseline ventilation in dorsal decubitus (DD), after 1 5 min of ventilation in VD and after 10 min of restored DD, the follow ing parameters were studied: arterial blood gas tension, haemodynamics and static respiratory compliance (Crs), evaluated with the rapid air way occlusion technique. Setting: The study was completed in the inten sive care units of university hospitals as part of the management of t he patients studied. Patients: Twelve patients (7 males, 5 females, me an age 51.8 +/- 16.6 years) suffering from ARDS of different aetiologi es. Interventions: Before and during each evaluation, the patients wer e kept under stable haemodynamic and metabolic conditions. The ventila tory setting was kept constant. All the patients were sedated, paralys ed and mechanically ventilated. Results: A statistically significant i ncrease in the ratio between the arterial partial pressure of oxygen a nd fractional inspired oxygen (p < 0.01) was observed between the base line conditions (mean 123.9 +/- 22.6) and VD (mean 153.0 +/- 16.9), wh ile no statistical significance was noted between baseline conditions and after 10 min of restored DD (mean 141.1 +/- 19.7). A significant i ncrease in Crs (p < 0.001) was observed between baseline conditions (m ean 42 +/- 10.1) and VD (mean 48.8 +/- 9.6) and between baseline condi tions and restored DD (mean 44.7 +/- 10.6). Two patients were consider ed nonresponders. All the patients were haemodynamically stable. No si de effects were noted. Conclusions: We observed an increase in oxygena tion and Crs when the patients were turned from the supine to the pron e position with the upper thorax and pelvis supported.