Prone position in a spontaneously breathing near-drowning patient

1999 ◽  
Vol 25 (12) ◽  
pp. 1469-1470 ◽  
Author(s):  
J. E. Tulleken ◽  
T. S. van der Werf ◽  
J. J. M. Ligtenberg ◽  
J.-W. Fijen ◽  
J. G. Zijlstra
Keyword(s):  
Prone Position ◽  
Near Drowning ◽  
Spontaneously Breathing

Topographical distribution of pulmonary perfusion and ventilation, assessed by PET in supine and prone humans

2002 ◽  
Vol 93 (5) ◽  
pp. 1841-1851 ◽  
Author(s):  
Guido Musch ◽  
J. Dominick H. Layfield ◽  
R. Scott Harris ◽  
Marcos F. Vidal Melo ◽  
Tilo Winkler ◽  
...  
Keyword(s):  
Prone Position ◽  
Emission Tomography ◽  
Washout Rate ◽  
Pulmonary Perfusion ◽  
Dependent Lung ◽  
Positron Emission ◽  
Topographical Distribution ◽  
Spontaneously Breathing ◽  
Gas Volume ◽  
Vertical Gradients

Using positron emission tomography (PET) and intravenously injected 13N2, we assessed the topographical distribution of pulmonary perfusion (Q˙) and ventilation (V˙) in six healthy, spontaneously breathing subjects in the supine and prone position. In this technique, the intrapulmonary distribution of 13N2, measured during a short apnea, is proportional to regional Q˙. After resumption of breathing, regional specific alveolar V˙(sV˙a, ventilation per unit of alveolar gas volume) can be calculated from the tracer washout rate. The PET scanner imaged 15 contiguous, 6-mm-thick, slices of lung. Vertical gradients ofQ˙ and sV˙a were computed by linear regression, and spatial heterogeneity was assessed from the squared coefficient of variation (CV2). Both CV[Formula: see text] and CV[Formula: see text] were corrected for the estimated contribution of random imaging noise. We found that 1) both Q˙ and V˙ had vertical gradients favoring dependent lung regions, 2) vertical gradients were similar in the supine and prone position and explained, on average, 24% ofQ˙ heterogeneity and 8% of V˙ heterogeneity, 3) CV[Formula: see text] was similar in the supine and prone position, and 4) CV[Formula: see text] was lower in the prone position. We conclude that, in recumbent, spontaneously breathing humans, 1) vertical gradients favoring dependent lung regions explain a significant fraction of heterogeneity, especially ofQ˙, and 2) although Q˙ does not seem to be systematically more homogeneous in the prone position, differences in individual behaviors may make the prone position advantageous, in terms of V˙-to-Q˙ matching, in selected subjects.

scholarly journals Prolonged Active Prone Positioning in Spontaneously Breathing Non-intubated Patients With COVID-19-Associated Hypoxemic Acute Respiratory Failure With PaO2/FiO2 >150

2021 ◽  
Vol 8 ◽  
Author(s):  
Paola Pierucci ◽  
Nicolino Ambrosino ◽  
Valentina Di Lecce ◽  
Michela Dimitri ◽  
Stefano Battaglia ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Prone Position ◽  
Hospital Length Of Stay ◽  
Respiratory Support ◽  
Control Group ◽  
Prone Positioning ◽  
Non Invasive ◽  
Hypoxemic Acute Respiratory Failure ◽  
Spontaneously Breathing

Background: The COVID-19 pandemic has led to new approaches to manage patients outside the ICU, including prone positioning in non-intubated patients.Objectives: To report the use of prolonged active prone positioning in spontaneously breathing patients with COVID-19-associated acute respiratory failure. Spontaneously breathing vs non-invasive respiratory support for COVID19 associated acute respiratory failure.Methods: Patients with PaO2/FiO2 > 150, with lung posterior consolidations as assessed by means of lung ultrasound, and chest x-ray were studied. Under continuous pulse oximetry (SpO2) monitoring, patients maintained active prone position. A PaO2/FiO2 < 150 was considered as treatment failure and patients had to be switched to non-invasive respiratory support. Retrospectively, data of 16 patients undergoing who refused proning and underwent non-invasive respiratory support were used as controls. The primary outcome was the proportion of patients maintaining prolonged prone position and discharged home. Secondary outcomes included improvement in oxygenation, hospital length of stay, and 6-month survival.Results: Three out of 16 (18.7%) patients did not tolerate the procedure. Three more patients showed a worsening in PaO2/FiO2 to <150 and required non-invasive support, two of whom finally needing endotracheal intubation. After 72 h, 10 out of 16 (62.5%) patients improved oxygenation [PaO2/FiO2: from 194.6 (42.1) to 304.7 (79.3.2) (p < 0.001)] and were discharged home. In the control group, three out of 16 failed, required invasive ventilatory support, and died within 1 month in ICU. Thirteen were successful and discharged home.Conclusion: In non-intubated spontaneously breathing COVID-19 patients with PaO2/FiO2 >150, active prolonged prone positioning was feasible and tolerated with significant improvement in oxygenation.

Pleural liquid pressure measured with rib capsules in anesthetized ponies

1988 ◽  
Vol 64 (1) ◽  
pp. 102-107 ◽  
Author(s):  
L. E. Olson ◽  
S. J. Lai-Fook
Keyword(s):  
Prone Position ◽  
Supine Position ◽  
Body Position ◽  
Transpulmonary Pressure ◽  
Vertical Gradient ◽  
Liquid Pressure ◽  
Minimal Distortion ◽  
Poor Ventilation ◽  
Spontaneously Breathing ◽  
Pleural Liquid Pressure

Pleural liquid pressure was measured at end expiration in 11 spontaneously breathing anesthetized ponies in the prone and supine positions. A liquid-filled capsule was implanted into a rib to measure pleural liquid pressure with minimal distortion of the pleural space (Wiener-Kronish et al., J. Appl. Physiol. 59: 597-602, 1985). Capsule position relative to lung height was measured from thoracic radiographs taken in each position. In each body position, pleural liquid pressure was most negative in the superior lung regions and least negative in the inferior lung regions. In the supine position, the magnitude of the vertical gradient in pleural liquid pressure was 0.67 cmH2O/cm ht and was not significantly different from 1 cmH2O/cm ht. In the inferior lung regions (less than 50% lung ht), pleural liquid pressure averaged -1.3 cmH2O, indicating a low transpulmonary pressure over the region of the chest where most of the lung mass is located. When animals were in the prone position, the magnitude of the vertical gradient in pleural liquid pressure was 0.14 cmH2O/cm ht and was not statistically different from 0 cmH2O/cm ht. In each body position, mean transpulmonary pressure, measured postmortem, was similar to the estimated magnitude of pleural liquid pressure at 50% lung ht. This suggests that pleural liquid pressure is closely related to pleural surface pressure. These results are consistent with the poor ventilation distribution and reduced lung volumes measured in anesthetized horses in the supine position compared with values measured in horses in the prone position.

Prone position in spontaneously breathing infants with pneumonia

2007 ◽  
Vol 88 (9) ◽  
pp. 1033-1034 ◽  
Author(s):  
T Chaisupamongkollarp ◽  
A Preutthipan ◽  
S Vaicheeta ◽  
T Chantarojanasiri ◽  
W Kongvivekkajornkij ◽  
...  
Keyword(s):  
Prone Position ◽  
Spontaneously Breathing

scholarly journals Effectiveness of prone position in spontaneously breathing patients with COVID-19: A prospective cohort study

2021 ◽  
pp. 175114372199654
Author(s):  
Brigitta Fazzini ◽  
Alex J Fowler ◽  
Parjam Zolfaghari
Keyword(s):  
Prone Position ◽  
Airway Pressure ◽  
Critical Care Unit ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Single Centre ◽  
Icu Length Of Stay ◽  
Single Centre Study ◽  
Novel Coronavirus ◽  
Spontaneously Breathing

We present a single centre study describing the effect of awake prone position (PP) on oxygenation and clinical outcomes in spontaneously breathing patients with novel coronavirus disease (COVID-19). Between 1st March and 30th April 2020, forty eight of 138 patients managed outside of the critical care unit with facemask oxygen, high flow nasal oxygen (HFNO) or continuous positive airway pressure (CPAP), underwent PP. Prone position was associated with significant improvement in oxygenation, lower ICU admission, tracheal intubation, and shorter ICU length of stay. Lack of response to PP may be an indicator of treatment failure, requiring early escalation.

scholarly journals Impact of Body Position on Lung Deposition of Nebulized Surfactant in Newborn Piglets on Nasal Continuous Positive Airway Pressure

Neonatology ◽  
2020 ◽  
Vol 117 (4) ◽  
pp. 467-473
Author(s):  
Doris Cunha-Goncalves ◽  
Anders Nord ◽  
Federico Bianco ◽  
Fabrizio Salomone ◽  
Francesca Ricci ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Prone Position ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Body Position ◽  
Lung Surfactant ◽  
Dependent Lung ◽  
Lateral Decubitus ◽  
The Right ◽  
Spontaneously Breathing

<b><i>Introduction:</i></b> The ideal body position during surfactant nebulization is not known. <b><i>Objective:</i></b> The aim of this study was to determine whether body positioning during surfactant nebulization influences surfactant distribution and deposition in the lungs. <b><i>Methods:</i></b> Twenty-four 12- to 36-h-old full-term<b><i></i></b>piglets (1.3–2.2 kg) on nasal continuous positive airway pressure (nCPAP) were randomized into four groups: lateral decubitus with right or left side up, prone or supine positions (<i>n</i> = 6 each). All animals received 200 mg kg<sup>–1</sup> of poractant alfa mixed with 200 MBq of <sup>99m</sup>technetium-nanocolloid via a customized eFlow-Neos investigational vibrating-membrane nebulizer. Surfactant deposition (percentage of the administered dose) was measured by gamma scintigraphy. <b><i>Results:</i></b> Comparing all groups, the mean total lung surfactant deposition was significantly higher in the prone position (32.4 ± 7.7%, <i>p</i> = 0.03). The deposition in this group was higher in the right lung (21.0 ± 8.6 vs. 11.3 ± 5.7%, <i>p</i> = 0.04). When nebulization was performed in the lateral decubitus, most of the surfactant was found in the dependent lung, regardless of which side the piglet lay on (right side up 15.3 ± 1.0 vs. 3.4 ± 1.0%, <i>p</i> = 0.06, and left side up 11.2 ± 9.8 vs. 1.8 ± 0.7%, <i>p</i> = 0.04). <b><i>Conclusions:</i></b> In spontaneously breathing animals on nCPAP, the prone position yielded the highest lung dose. Higher deposition rates in the dependent lung while on lateral decubitus indicates that deposition was also influenced by gravity.

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