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Prone position in ARDS patients: why, when, how and for whom
- Source :
- Intensive Care Medicine, Intensive Care Medicine, 2020, 46 (12), pp.2385-2396. ⟨10.1007/s00134-020-06306-w⟩, Intensive Care Medicine, Springer Verlag, 2020, 46 (12), pp.2385-2396. ⟨10.1007/s00134-020-06306-w⟩
- Publication Year :
- 2020
- Publisher :
- HAL CCSD, 2020.
-
Abstract
- In ARDS patients, the change from supine to prone position generates a more even distribution of the gas–tissue ratios along the dependent–nondependent axis and a more homogeneous distribution of lung stress and strain. The change to prone position is generally accompanied by a marked improvement in arterial blood gases, which is mainly due to a better overall ventilation/perfusion matching. Improvement in oxygenation and reduction in mortality are the main reasons to implement prone position in patients with ARDS. The main reason explaining a decreased mortality is less overdistension in non-dependent lung regions and less cyclical opening and closing in dependent lung regions. The only absolute contraindication for implementing prone position is an unstable spinal fracture. The maneuver to change from supine to prone and vice versa requires a skilled team of 4–5 caregivers. The most frequent adverse events are pressure sores and facial edema. Recently, the use of prone position has been extended to non-intubated spontaneously breathing patients affected with COVID-19 ARDS. The effects of this intervention on outcomes are still uncertain. Electronic supplementary material The online version of this article (10.1007/s00134-020-06306-w) contains supplementary material, which is available to authorized users.
- Subjects :
- ARDS
medicine.medical_specialty
Supine position
[SDV]Life Sciences [q-bio]
Gravity
Review
Pulmonary compliance
Critical Care and Intensive Care Medicine
Ventilation/perfusion ratio
03 medical and health sciences
Lung protective ventilation
Prone position
0302 clinical medicine
Internal medicine
medicine
Humans
Lung Compliance
Contraindication
Respiratory Distress Syndrome
Acute respiratory distress syndrome
business.industry
030208 emergency & critical care medicine
medicine.disease
3. Good health
[SDV] Life Sciences [q-bio]
030228 respiratory system
Ventilation/perfusion
Respiratory Mechanics
Breathing
Cardiology
business
Subjects
Details
- Language :
- English
- ISSN :
- 03424642 and 14321238
- Database :
- OpenAIRE
- Journal :
- Intensive Care Medicine, Intensive Care Medicine, 2020, 46 (12), pp.2385-2396. ⟨10.1007/s00134-020-06306-w⟩, Intensive Care Medicine, Springer Verlag, 2020, 46 (12), pp.2385-2396. ⟨10.1007/s00134-020-06306-w⟩
- Accession number :
- edsair.doi.dedup.....a2fa7198f9756a282cb3ef42978658f1