Cited by 486Respiratory Support and MechanismsNeonatal Respiratory Health ResearchInterstitial Lung Diseases and Idiopathic Pulmonary Fibrosis

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Mechanism by Which the Prone Position Improves Oxygenation in Acute Lung Injury

Lamm, W J, Graham, M M, Albert, R K·1994·American journal of respiratory and critical care medicine

DOI 10.1164/ajrccm.150.1.8025748

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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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Authors: Lamm, W. J., Graham, M. M., & Albert, R. K.
Affiliations: University of Washington (US)
ORCID: Graham, M M
Albert, R K
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
DOI: 10.1164/ajrccm.150.1.8025748
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
Licence: academic.oup.com/pages/standard-publication-reuse-rights (vor)
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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Mechanism by Which the Prone Position Improves Oxygenation in Acute Lung Injury

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