Prone position in acute respiratory distress syndrome. Rationale, indications, and limits.
Identifieur interne : 000256 ( Main/Exploration ); précédent : 000255; suivant : 000257Prone position in acute respiratory distress syndrome. Rationale, indications, and limits.
Auteurs : Luciano Gattinoni [Italie] ; Paolo Taccone ; Eleonora Carlesso ; John J. MariniSource :
- American journal of respiratory and critical care medicine [ 1535-4970 ] ; 2013.
Descripteurs français
- KwdFr :
- Analyse de survie (MeSH), Capacité pulmonaire totale (physiologie), Décubitus dorsal (physiologie), Décubitus ventral (physiologie), Essais cliniques comme sujet (MeSH), Humains (MeSH), Lésion pulmonaire induite par la ventilation mécanique (prévention et contrôle), Positionnement du patient (MeSH), Poumon (physiologie), Poumon (physiopathologie), Syndrome de détresse respiratoire de l'adulte (thérapie), Ventilation artificielle (effets indésirables), Ventilation artificielle (méthodes), Échanges gazeux pulmonaires (physiologie).
- MESH :
- effets indésirables : Ventilation artificielle.
- méthodes : Ventilation artificielle.
- physiologie : Capacité pulmonaire totale, Décubitus dorsal, Décubitus ventral, Poumon, Échanges gazeux pulmonaires.
- physiopathologie : Poumon.
- prévention et contrôle : Lésion pulmonaire induite par la ventilation mécanique.
- thérapie : Syndrome de détresse respiratoire de l'adulte.
- Analyse de survie, Essais cliniques comme sujet, Humains, Positionnement du patient.
English descriptors
- KwdEn :
- Clinical Trials as Topic (MeSH), Humans (MeSH), Lung (physiology), Lung (physiopathology), Patient Positioning (MeSH), Prone Position (physiology), Pulmonary Gas Exchange (physiology), Respiration, Artificial (adverse effects), Respiration, Artificial (methods), Respiratory Distress Syndrome, Adult (therapy), Supine Position (physiology), Survival Analysis (MeSH), Total Lung Capacity (physiology), Ventilator-Induced Lung Injury (prevention & control).
- MESH :
- adverse effects : Respiration, Artificial.
- methods : Respiration, Artificial.
- physiology : Lung, Prone Position, Pulmonary Gas Exchange, Supine Position, Total Lung Capacity.
- physiopathology : Lung.
- prevention & control : Ventilator-Induced Lung Injury.
- therapy : Respiratory Distress Syndrome, Adult.
- Clinical Trials as Topic, Humans, Patient Positioning, Survival Analysis.
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.
DOI: 10.1164/rccm.201308-1532CI
PubMed: 24134414
Affiliations:
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Marini</name></author></analytic><series><title level="j">American journal of respiratory and critical care medicine</title><idno type="eISSN">1535-4970</idno><imprint><date when="2013" type="published">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Clinical Trials as Topic (MeSH)</term><term>Humans (MeSH)</term><term>Lung (physiology)</term><term>Lung (physiopathology)</term><term>Patient Positioning (MeSH)</term><term>Prone Position (physiology)</term><term>Pulmonary Gas Exchange (physiology)</term><term>Respiration, Artificial (adverse effects)</term><term>Respiration, Artificial (methods)</term><term>Respiratory Distress Syndrome, Adult (therapy)</term><term>Supine Position (physiology)</term><term>Survival Analysis (MeSH)</term><term>Total Lung Capacity (physiology)</term><term>Ventilator-Induced Lung Injury (prevention & control)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Analyse de survie (MeSH)</term><term>Capacité pulmonaire totale (physiologie)</term><term>Décubitus dorsal (physiologie)</term><term>Décubitus ventral (physiologie)</term><term>Essais cliniques comme sujet (MeSH)</term><term>Humains (MeSH)</term><term>Lésion pulmonaire induite par la ventilation mécanique (prévention et contrôle)</term><term>Positionnement du patient (MeSH)</term><term>Poumon (physiologie)</term><term>Poumon (physiopathologie)</term><term>Syndrome de détresse respiratoire de l'adulte (thérapie)</term><term>Ventilation artificielle (effets indésirables)</term><term>Ventilation artificielle (méthodes)</term><term>Échanges gazeux pulmonaires (physiologie)</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Respiration, Artificial</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Ventilation artificielle</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Respiration, Artificial</term></keywords><keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Ventilation artificielle</term></keywords><keywords scheme="MESH" qualifier="physiologie" xml:lang="fr"><term>Capacité pulmonaire totale</term><term>Décubitus dorsal</term><term>Décubitus ventral</term><term>Poumon</term><term>Échanges gazeux pulmonaires</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Lung</term><term>Prone Position</term><term>Pulmonary Gas Exchange</term><term>Supine Position</term><term>Total Lung Capacity</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Poumon</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Lung</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Ventilator-Induced Lung Injury</term></keywords><keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Lésion pulmonaire induite par la ventilation mécanique</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Syndrome de détresse respiratoire de l'adulte</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Clinical Trials as Topic</term><term>Humans</term><term>Patient Positioning</term><term>Survival Analysis</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Analyse de survie</term><term>Essais cliniques comme sujet</term><term>Humains</term><term>Positionnement du patient</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">24134414</PMID><DateCompleted><Year>2014</Year><Month>02</Month><Day>03</Day></DateCompleted><DateRevised><Year>2013</Year><Month>12</Month><Day>02</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1535-4970</ISSN><JournalIssue CitedMedium="Internet"><Volume>188</Volume><Issue>11</Issue><PubDate><Year>2013</Year><Month>Dec</Month><Day>01</Day></PubDate></JournalIssue><Title>American journal of respiratory and critical care medicine</Title></Journal><ArticleTitle>Prone position in acute respiratory distress syndrome. Rationale, indications, and limits.</ArticleTitle><Pagination><MedlinePgn>1286-93</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1164/rccm.201308-1532CI</ELocationID><Abstract><AbstractText>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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Gattinoni</LastName><ForeName>Luciano</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>1 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Taccone</LastName><ForeName>Paolo</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Carlesso</LastName><ForeName>Eleonora</ForeName><Initials>E</Initials></Author><Author ValidYN="Y"><LastName>Marini</LastName><ForeName>John J</ForeName><Initials>JJ</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Am J Respir Crit Care Med</MedlineTA><NlmUniqueID>9421642</NlmUniqueID><ISSNLinking>1073-449X</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D002986" MajorTopicYN="N">Clinical Trials as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008168" MajorTopicYN="N">Lung</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D056888" MajorTopicYN="Y">Patient Positioning</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016684" MajorTopicYN="N">Prone Position</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011659" MajorTopicYN="N">Pulmonary Gas Exchange</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="Y">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012121" MajorTopicYN="N">Respiration, Artificial</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016683" MajorTopicYN="N">Supine Position</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016019" MajorTopicYN="N">Survival Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014109" MajorTopicYN="N">Total Lung Capacity</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D055397" MajorTopicYN="N">Ventilator-Induced Lung Injury</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2013</Year><Month>10</Month><Day>19</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2013</Year><Month>10</Month><Day>19</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2014</Year><Month>2</Month><Day>4</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">24134414</ArticleId><ArticleId IdType="doi">10.1164/rccm.201308-1532CI</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Italie</li></country><region><li>Lombardie</li></region><settlement><li>Milan</li></settlement></list><tree><noCountry><name sortKey="Carlesso, Eleonora" sort="Carlesso, Eleonora" uniqKey="Carlesso E" first="Eleonora" last="Carlesso">Eleonora Carlesso</name><name sortKey="Marini, John J" sort="Marini, John J" uniqKey="Marini J" first="John J" last="Marini">John J. Marini</name><name sortKey="Taccone, Paolo" sort="Taccone, Paolo" uniqKey="Taccone P" first="Paolo" last="Taccone">Paolo Taccone</name></noCountry><country name="Italie"><region name="Lombardie"><name sortKey="Gattinoni, Luciano" sort="Gattinoni, Luciano" uniqKey="Gattinoni L" first="Luciano" last="Gattinoni">Luciano Gattinoni</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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