Mechanism by Which the Prone Position Improves Oxygenation in Acute Lung Injury
Abstract
The mechanism by which oxygenation improves when patients with ARDS are turned from supine to prone position is not known. From results of our previous studies we reasoned that (1) when supine, in the setting of lung injury, transpulmonary pressure will be less than airway opening pressure and (2) atelectasis will develop preferentially in dorsal lung areas, and (3) both ventilation and ventilation/perfusion ratios would improve in these regions on turning prone. To study this directly, we measured regional ventilation and perfusion using 81mKr and 99mTc-MAA, respectively, and single photon emission computed tomography, both prone and supine, in four control animals and four given oleic acid. After oleic acid, the prone position improved (1) oxygenation (mean +/- SD PaO2 = 140 +/- 112 versus 453 +/- 54 mm Hg), (2) median ventilation/perfusion ratios (0.77 versus 0.95), (3) ventilation/perfusion heterogeneity (coefficient of variation 86 +/- 15 versus 61 +/- 6), and (4) the gravitational ventilation/perfusion gradient (dependent to non-dependent slopes of 0.22 versus -0.02, all p < 0.05). The prone position generates a transpulmonary pressure sufficient to exceed airway opening pressure in dorsal lung regions, i.e., in regions where atelectasis, shunt, and ventilation/perfusion heterogeneity are most severe, without adversely affecting ventral lung regions.
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Most patients respond to the prone position with improved oxygenation and may also have improved lung compliance.
“Most patients respond to the prone position with improved oxygenation and may also have improved lung compliance [457–459].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [458]
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- Authors
- Lamm, W. J., Graham, M. M., & Albert, R. K.
- Affiliations
- University of Washington (US)
- Venue
- American journal of respiratory and critical care medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 1994-07-01
- Volume
- 150
- Issue
- 1
- Pages
- 184-193
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2082839305
- Cited by
- 486
- References
- 25
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 16 · 2023: 7 · 2022: 22 · 2021: 13 · 2020: 11 · 2019: 5 · 2018: 3 · 2017: 10 · 2016: 9 · 2015: 15 · 2014: 18 · 2013: 10 · 2012: 10
- FWCI
- 13.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
- Keywords
- prone positioning, acute lung injury, acute respiratory distress syndrome, oxygenation, regional ventilation, regional perfusion, atelectasis, oleic acid-induced lung injury, transpulmonary pressure, airway opening pressure, shunt
- MeSH terms
- Animals, Dogs, Female, Hemodynamics, Lung, Male, Oxygen, Pulmonary Gas Exchange, Respiratory Distress Syndrome, Ventilation-Perfusion Ratio, Tomography, Emission-Computed, Single-Photon, Supine Position, Prone Position
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