Journal ArticleDOI
Prone Position in Acute Respiratory Distress Syndrome. Rationale, Indications, and Limits
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TLDR
The bulk of data indicates that in severe acute respiratory distress syndrome, carefully performed prone positioning offers an absolute survival advantage of 10-17%, making this intervention highly recommended in this specific population subset.Abstract:
In the prone position, computed tomography scan densities redistribute from dorsal to ventral as the dorsal region tends to reexpand while the ventral zone tends to collapse. Although gravitational influence is similar in both positions, dorsal recruitment usually prevails over ventral derecruitment, because of the need for the lung and its confining chest wall to conform to the same volume. The final result of proning is that the overall lung inflation is more homogeneous from dorsal to ventral than in the supine position, with more homogeneously distributed stress and strain. As the distribution of perfusion remains nearly constant in both postures, proning usually improves oxygenation. Animal experiments clearly show that prone positioning delays or prevents ventilation-induced lung injury, likely due in large part to more homogeneously distributed stress and strain. Over the last 15 years, five major trials have been conducted to compare the prone and supine positions in acute respiratory distress syndrome, regarding survival advantage. The sequence of trials enrolled patients who were progressively more hypoxemic; exposure to the prone position was extended from 8 to 17 hours/day, and lung-protective ventilation was more rigorously applied. Single-patient and meta-analyses drawing from the four major trials showed significant survival benefit in patients with PaO2/FiO2 lower than 100. The latest PROSEVA (Proning Severe ARDS Patients) trial confirmed these benefits in a formal randomized study. The bulk of data indicates that in severe acute respiratory distress syndrome, carefully performed prone positioning offers an absolute survival advantage of 10-17%, making this intervention highly recommended in this specific population subset.read more
Citations
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Journal ArticleDOI
COVID-19 Does Not Lead to a "Typical" Acute Respiratory Distress Syndrome.
Luciano Gattinoni,Silvia Coppola,Massimo Cressoni,Mattia Busana,Sandra Rossi,Davide Chiumello +5 more
TL;DR: It is found that hypercapnia was common in patients with COVID-19–associated ARDS while using low VT ventilation, and low VT may not be the best approach for all patients with ARDS, particularly those with a less severe decrease in respiratory system compliance and inadequacy of ventilation.
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Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment
TL;DR: The Berlin definition of acute respiratory distress syndrome addressed limitations of the American-European Consensus Conference definition, but poor reliability of some criteria may contribute to underrecognition by clinicians.
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COVID-19 pneumonia: ARDS or not?
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Mechanical Power and Development of Ventilator-induced Lung Injury
Massimo Cressoni,Miriam Gotti,Chiara Chiurazzi,D Massari,I Algieri,M Amini,A Cammaroto,Matteo Brioni,C Montaruli,K Nikolla,M. Guanziroli,Daniele Dondossola,Stefano Gatti,Vincenza Valerio,Giordano Luca Vergani,P. Pugni,Paolo Cadringher,Nicoletta Gagliano,Luciano Gattinoni +18 more
TL;DR: In piglets, VILI develops if a mechanical power threshold is exceeded, and a significant relationship between the mechanical power applied to the lung and the increase in lung weight and lung elastance is found.
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Treatment of ARDS With Prone Positioning
TL;DR: This trial, and subsequent meta-analyses, support the role of prone positioning as an effective therapy to reduce mortality in severe ARDS, particularly when applied early with other lung-protective strategies.
References
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Roy G. Brower,Michael A. Matthay,Alan H. Morris,David A. Schoenfeld,B. Taylor Thompson,Arthur P. Wheeler +5 more
TL;DR: In patients with acute lung injury and the acute respiratory distress syndrome, mechanical ventilation with a lower tidal volume than is traditionally used results in decreased mortality and increases the number of days without ventilator use.
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Acute respiratory distress syndrome: the Berlin Definition.
Ards Definition Task Force,V. Marco Ranieri,Gordon D. Rubenfeld,B. Taylor Thompson,Niall D. Ferguson,Ellen Caldwell,Eddy Fan,Luigi Camporota,Luigi Camporota,Arthur S. Slutsky +9 more
TL;DR: The updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition and may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.
Journal ArticleDOI
Prone Positioning in Severe Acute Respiratory Distress Syndrome
Claude Guérin,Jean Reignier,Jean-Christophe Richard,Pascal Beuret,Arnaud Gacouin,Thierry Boulain,Emmanuelle Mercier,Michel Badet,Alain Mercat,Olivier Baudin,Marc Clavel,Delphine Chatellier,Samir Jaber,Sylvène Rosselli,Jordi Mancebo,Michel Sirodot,Gilles Hilbert,Christian Bengler,Jack Richecoeur,Marc Gainnier,Frédérique Bayle,Gael Bourdin,Véronique Leray,Raphaële Girard,Loredana Baboi,Louis Ayzac +25 more
TL;DR: In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality.
Journal ArticleDOI
Ventilator-induced lung injury: lessons from experimental studies.
Didier Dreyfuss,Georges Saumon +1 more
TL;DR: This paper presents experimental evidence for Increased Vascular Transmural Pressure Evidence for Alterations in Alveolar–Capillary Permeability Contributions of the Static and Dynamic Lung Volume Components to Ventilator-induced Edema High-volume Lung Edema Low Lung Volume Injury.
Journal ArticleDOI
Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome
Laurent Papazian,Jean-Marie Forel,Arnaud Gacouin,Christine Penot-Ragon,Gilles Perrin,Anderson Loundou,Samir Jaber,Jean-Michel Arnal,Didier Perez,Jean-Marie Seghboyan,Jean-Michel Constantin,Pierre Courant,Jean-Yves Lefrant,Claude Guérin,Gwenaël Prat,Sophie Morange,Antoine Roch +16 more
TL;DR: In patients with severe ARDS, early administration of a neuromuscular blocking agent improved the adjusted 90-day survival and increased the time off the ventilator without increasing muscle weakness.
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