prone position and recruitment manoeuvre the combined effect improves oxygenation卧姿和招聘策略的综合效应改善氧合.pdfVIP

Rival et al. Critical Care 2011, 15:R125 /content/15/3/R125 RESEARCH Open Access Prone position and recruitment manoeuvre: the combined effect improves oxygenation 1* 2 3 2 2 2,4 Gilles Rival , Cyrille Patry , Nathalie Floret , Jean Christophe Navellou , Evelyne Belle and Gilles Capellier Abstract Introduction: Among the various methods for improving oxygenation while decreasing the risk of ventilation- induced lung injury in patients with acute respiratory distress syndrome (ARDS), a ventilation strategy combining prone position (PP) and recruitment manoeuvres (RMs) can be practiced. We studied the effects on oxygenation of both RM and PP applied in early ARDS patients. Methods: We conducted a prospective study. Sixteen consecutive patients with early ARDS fulfilling our criteria (ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO /FiO ) 98.3 ± 28 mmHg; positive end 2 2 expiratory pressure, 10.7 ± 2.8 cmH2O) were analysed. Each patient was ventilated in both the supine position (SP) and the PP (six hours in each position). A 45 cmH2O extended sigh in pressure control mode was performed at the beginning of SP (RM1), one hour after turning to the PP (RM2) and at the end of the six-hour PP period (RM3). Results: The mean arterial oxygen partial pressure (PaO2) changes after RM1, RM2 and RM3 were 9.6%, 15% and 19%, respectively. The PaO2 improvement after a single RM was significant after RM3 only (P 0.05). Improvements in PaO level and PaO /FiO ratio were transient in SP but durable during PP. PaO /FiO ratio peaked at 218 m