Prone position in mechanically ventilated patients – the hard or the soft way 英文参考文献.docVIP

Available online /content/9/3/253 Commentary Prone position in mechanically ventilated patients – the hard or the soft way? Christian Putensen Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany Corresponding author: Christian Putensen, Christian.Putensen@ukb.uni-bonn.de Published online: 5 May 2005 Critical Care 2005, 9:253-254 (DOI 10.1186/cc3534) This article is online at /content/9/3/253 ? 2005 BioMed Central Ltd See related research by Michelet et al. in this issue [/content/9/3/R251] Abstract oxygenation with prone positioning [5]. These data support the contention that simply turning the patient prone without minimizing restriction of the abdomen should be sufficient to improve arterial blood oxygenation in ARDS [6-9]. However, patients with ARDS rarely die from hypoxia and/or hypercapnia but commonly develop systemic inflammatory response with cardiocirculatory instability and impaired organ perfusion that culminates in multiple organ system dysfunction syndrome and death [10]. Most recently, Malbrain and coworkers [11] demonstrated that IAP above 12 mmHg is associated with severe organ dysfunction in critically ill patients. Increased IAP, even at unchanged arterial pressures, will result in decreased abdominal perfusion pressure, which is strongly associated with development of organ dysfunction and reduced survival in critically ill patients [12]. Prone positioning may even in patients without abdominal hypertension result in an increased intra-abdominal pressure (IAP). Previous research could not demonstrate a marked increase in IAP associated with cardiovascular, renal, or hepato-splanchnic dysfunction when patients were proned in air-cushioned beds. Michelet and colleagues in this issue of Critical Care report that the increase in IAP in the prone position depends on the used mattress type. Compared with