Effects of prone position and positive end-expiratory pressure on lung perfusion and ventilation.
Identifieur interne : 000362 ( Main/Exploration ); précédent : 000361; suivant : 000363Effects of prone position and positive end-expiratory pressure on lung perfusion and ventilation.
Auteurs : Jean-Christophe Richard [France] ; Fabienne Bregeon ; Nicolas Costes ; Didier L E. Bars ; Christian Tourvieille ; Franck Lavenne ; Marc Janier ; Gaël Bourdin ; Gérard Gimenez ; Claude GuerinSource :
- Critical care medicine [ 1530-0293 ] ; 2008.
Descripteurs français
- KwdFr :
- Animaux (MeSH), Circulation pulmonaire (MeSH), Décubitus ventral (MeSH), Femelle (MeSH), Gazométrie sanguine (MeSH), Hémodynamique (MeSH), Modèles animaux de maladie humaine (MeSH), Respiration (MeSH), Suidae (MeSH), Syndrome de détresse respiratoire de l'adulte (thérapie), Tomographie par émission de positons (MeSH), Ventilation à pression positive (MeSH).
- MESH :
English descriptors
- KwdEn :
- Animals (MeSH), Blood Gas Analysis (MeSH), Disease Models, Animal (MeSH), Female (MeSH), Hemodynamics (MeSH), Positive-Pressure Respiration (MeSH), Positron-Emission Tomography (MeSH), Prone Position (MeSH), Pulmonary Circulation (MeSH), Respiration (MeSH), Respiratory Distress Syndrome, Adult (therapy), Swine (MeSH).
- MESH :
Abstract
OBJECTIVES
Prone positioning is frequently used during acute respiratory distress syndrome. However, mechanisms by which it improves oxygenation are poorly understood, as well as its interaction with positive end-expiratory pressure. This study was conducted to decipher the respective effects of positive end-expiratory pressure and posture during lung injury on regional lung ventilation, perfusion and recruitment assessed by positron emission tomography.
DESIGN
Experimental study.
SETTING
Research laboratory of a university hospital.
SUBJECTS
Six female piglets.
INTERVENTIONS
After oleic acid-induced lung injury, all animals were studied in supine and prone position at both positive end-expiratory pressure 0 and positive end-expiratory pressure 10 cm H2O.
MEASUREMENTS AND MAIN RESULTS
In each experimental condition, regional lung perfusion and ventilation were assessed with positron emission tomograph using intravenous 15O-labeled water and inhaled nitrogen-13. Nonaerated lung weight was assessed with positron emission tomograph, and alveolar recruitment was defined as the difference of nonaerated lung weight between conditions. Positive end-expiratory pressure was associated with significant alveolar recruitment (130 +/- 85 and 65 +/- 29 g of lung in supine and prone position, respectively [p < 0.05 vs. 0]), whereas recruitment induced by posture was not statistically significant (77 +/- 97 g with positive end-expiratory pressure 0 and 13 +/- 19 g with positive end-expiratory pressure 10 [p > 0.05 vs. 0]). Regardless the posture, positive end-expiratory pressure redistributed both perfusion and ventilation toward dependent regions. Recruitment by positive end-expiratory pressure was restricted to dorsal regions in supine position, but extended diffusely along the ventral-to-dorsal dimension in prone position. Prone position was associated with recruitment in dorsal regions with concomitant derecruitment in ventral regions, magnitude of this being reduced by positive end-expiratory pressure. Prone position redistributed ventilation toward dorsal and ventral regions at positive end-expiratory pressure 0 and positive end-expiratory pressure, respectively. Finally, prone position redistributed perfusion toward ventral regions, to an extent amplified by positive end-expiratory pressure.
CONCLUSIONS
Positive end-expiratory pressure and posture act synergistically by redistributing lung regional perfusion toward ventral regions, but have antagonistic effects on regional ventilation.
DOI: 10.1097/CCM.0b013e31818094a9
PubMed: 18596639
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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Bars</name></author><author><name sortKey="Tourvieille, Christian" sort="Tourvieille, Christian" uniqKey="Tourvieille C" first="Christian" last="Tourvieille">Christian Tourvieille</name></author><author><name sortKey="Lavenne, Franck" sort="Lavenne, Franck" uniqKey="Lavenne F" first="Franck" last="Lavenne">Franck Lavenne</name></author><author><name sortKey="Janier, Marc" sort="Janier, Marc" uniqKey="Janier M" first="Marc" last="Janier">Marc Janier</name></author><author><name sortKey="Bourdin, Gael" sort="Bourdin, Gael" uniqKey="Bourdin G" first="Gaël" last="Bourdin">Gaël Bourdin</name></author><author><name sortKey="Gimenez, Gerard" sort="Gimenez, Gerard" uniqKey="Gimenez G" first="Gérard" last="Gimenez">Gérard Gimenez</name></author><author><name sortKey="Guerin, Claude" sort="Guerin, Claude" uniqKey="Guerin C" first="Claude" last="Guerin">Claude Guerin</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2008">2008</date><idno type="RBID">pubmed:18596639</idno><idno type="pmid">18596639</idno><idno type="doi">10.1097/CCM.0b013e31818094a9</idno><idno type="wicri:Area/Main/Corpus">000351</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000351</idno><idno type="wicri:Area/Main/Curation">000351</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000351</idno><idno type="wicri:Area/Main/Exploration">000351</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Effects of prone position and positive end-expiratory pressure on lung perfusion and ventilation.</title><author><name sortKey="Richard, Jean Christophe" sort="Richard, Jean Christophe" uniqKey="Richard J" first="Jean-Christophe" last="Richard">Jean-Christophe Richard</name><affiliation wicri:level="3"><nlm:affiliation>Hospices civils de Lyon, Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Hospices civils de Lyon, Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="Bregeon, Fabienne" sort="Bregeon, Fabienne" uniqKey="Bregeon F" first="Fabienne" last="Bregeon">Fabienne Bregeon</name></author><author><name sortKey="Costes, Nicolas" sort="Costes, Nicolas" uniqKey="Costes N" first="Nicolas" last="Costes">Nicolas Costes</name></author><author><name sortKey="Bars, Didier L E" sort="Bars, Didier L E" uniqKey="Bars D" first="Didier L E" last="Bars">Didier L E. Bars</name></author><author><name sortKey="Tourvieille, Christian" sort="Tourvieille, Christian" uniqKey="Tourvieille C" first="Christian" last="Tourvieille">Christian Tourvieille</name></author><author><name sortKey="Lavenne, Franck" sort="Lavenne, Franck" uniqKey="Lavenne F" first="Franck" last="Lavenne">Franck Lavenne</name></author><author><name sortKey="Janier, Marc" sort="Janier, Marc" uniqKey="Janier M" first="Marc" last="Janier">Marc Janier</name></author><author><name sortKey="Bourdin, Gael" sort="Bourdin, Gael" uniqKey="Bourdin G" first="Gaël" last="Bourdin">Gaël Bourdin</name></author><author><name sortKey="Gimenez, Gerard" sort="Gimenez, Gerard" uniqKey="Gimenez G" first="Gérard" last="Gimenez">Gérard Gimenez</name></author><author><name sortKey="Guerin, Claude" sort="Guerin, Claude" uniqKey="Guerin C" first="Claude" last="Guerin">Claude Guerin</name></author></analytic><series><title level="j">Critical care medicine</title><idno type="eISSN">1530-0293</idno><imprint><date when="2008" type="published">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Animals (MeSH)</term><term>Blood Gas Analysis (MeSH)</term><term>Disease Models, Animal (MeSH)</term><term>Female (MeSH)</term><term>Hemodynamics (MeSH)</term><term>Positive-Pressure Respiration (MeSH)</term><term>Positron-Emission Tomography (MeSH)</term><term>Prone Position (MeSH)</term><term>Pulmonary Circulation (MeSH)</term><term>Respiration (MeSH)</term><term>Respiratory Distress Syndrome, Adult (therapy)</term><term>Swine (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Animaux (MeSH)</term><term>Circulation pulmonaire (MeSH)</term><term>Décubitus ventral (MeSH)</term><term>Femelle (MeSH)</term><term>Gazométrie sanguine (MeSH)</term><term>Hémodynamique (MeSH)</term><term>Modèles animaux de maladie humaine (MeSH)</term><term>Respiration (MeSH)</term><term>Suidae (MeSH)</term><term>Syndrome de détresse respiratoire de l'adulte (thérapie)</term><term>Tomographie par émission de positons (MeSH)</term><term>Ventilation à pression positive (MeSH)</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>Animals</term><term>Blood Gas Analysis</term><term>Disease Models, Animal</term><term>Female</term><term>Hemodynamics</term><term>Positive-Pressure Respiration</term><term>Positron-Emission Tomography</term><term>Prone Position</term><term>Pulmonary Circulation</term><term>Respiration</term><term>Swine</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Animaux</term><term>Circulation pulmonaire</term><term>Décubitus ventral</term><term>Femelle</term><term>Gazométrie sanguine</term><term>Hémodynamique</term><term>Modèles animaux de maladie humaine</term><term>Respiration</term><term>Suidae</term><term>Tomographie par émission de positons</term><term>Ventilation à pression positive</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>Prone positioning is frequently used during acute respiratory distress syndrome. However, mechanisms by which it improves oxygenation are poorly understood, as well as its interaction with positive end-expiratory pressure. This study was conducted to decipher the respective effects of positive end-expiratory pressure and posture during lung injury on regional lung ventilation, perfusion and recruitment assessed by positron emission tomography.</p></div><div type="abstract" xml:lang="en"><p><b>DESIGN</b></p><p>Experimental study.</p></div><div type="abstract" xml:lang="en"><p><b>SETTING</b></p><p>Research laboratory of a university hospital.</p></div><div type="abstract" xml:lang="en"><p><b>SUBJECTS</b></p><p>Six female piglets.</p></div><div type="abstract" xml:lang="en"><p><b>INTERVENTIONS</b></p><p>After oleic acid-induced lung injury, all animals were studied in supine and prone position at both positive end-expiratory pressure 0 and positive end-expiratory pressure 10 cm H2O.</p></div><div type="abstract" xml:lang="en"><p><b>MEASUREMENTS AND MAIN RESULTS</b></p><p>In each experimental condition, regional lung perfusion and ventilation were assessed with positron emission tomograph using intravenous 15O-labeled water and inhaled nitrogen-13. Nonaerated lung weight was assessed with positron emission tomograph, and alveolar recruitment was defined as the difference of nonaerated lung weight between conditions. Positive end-expiratory pressure was associated with significant alveolar recruitment (130 +/- 85 and 65 +/- 29 g of lung in supine and prone position, respectively [p < 0.05 vs. 0]), whereas recruitment induced by posture was not statistically significant (77 +/- 97 g with positive end-expiratory pressure 0 and 13 +/- 19 g with positive end-expiratory pressure 10 [p > 0.05 vs. 0]). Regardless the posture, positive end-expiratory pressure redistributed both perfusion and ventilation toward dependent regions. Recruitment by positive end-expiratory pressure was restricted to dorsal regions in supine position, but extended diffusely along the ventral-to-dorsal dimension in prone position. Prone position was associated with recruitment in dorsal regions with concomitant derecruitment in ventral regions, magnitude of this being reduced by positive end-expiratory pressure. Prone position redistributed ventilation toward dorsal and ventral regions at positive end-expiratory pressure 0 and positive end-expiratory pressure, respectively. Finally, prone position redistributed perfusion toward ventral regions, to an extent amplified by positive end-expiratory pressure.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Positive end-expiratory pressure and posture act synergistically by redistributing lung regional perfusion toward ventral regions, but have antagonistic effects on regional ventilation.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">18596639</PMID><DateCompleted><Year>2008</Year><Month>08</Month><Day>25</Day></DateCompleted><DateRevised><Year>2008</Year><Month>07</Month><Day>31</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1530-0293</ISSN><JournalIssue CitedMedium="Internet"><Volume>36</Volume><Issue>8</Issue><PubDate><Year>2008</Year><Month>Aug</Month></PubDate></JournalIssue><Title>Critical care medicine</Title></Journal><ArticleTitle>Effects of prone position and positive end-expiratory pressure on lung perfusion and ventilation.</ArticleTitle><Pagination><MedlinePgn>2373-80</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1097/CCM.0b013e31818094a9</ELocationID><Abstract><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">Prone positioning is frequently used during acute respiratory distress syndrome. However, mechanisms by which it improves oxygenation are poorly understood, as well as its interaction with positive end-expiratory pressure. This study was conducted to decipher the respective effects of positive end-expiratory pressure and posture during lung injury on regional lung ventilation, perfusion and recruitment assessed by positron emission tomography.</AbstractText><AbstractText Label="DESIGN" NlmCategory="METHODS">Experimental study.</AbstractText><AbstractText Label="SETTING" NlmCategory="METHODS">Research laboratory of a university hospital.</AbstractText><AbstractText Label="SUBJECTS" NlmCategory="METHODS">Six female piglets.</AbstractText><AbstractText Label="INTERVENTIONS" NlmCategory="METHODS">After oleic acid-induced lung injury, all animals were studied in supine and prone position at both positive end-expiratory pressure 0 and positive end-expiratory pressure 10 cm H2O.</AbstractText><AbstractText Label="MEASUREMENTS AND MAIN RESULTS" NlmCategory="RESULTS">In each experimental condition, regional lung perfusion and ventilation were assessed with positron emission tomograph using intravenous 15O-labeled water and inhaled nitrogen-13. Nonaerated lung weight was assessed with positron emission tomograph, and alveolar recruitment was defined as the difference of nonaerated lung weight between conditions. Positive end-expiratory pressure was associated with significant alveolar recruitment (130 +/- 85 and 65 +/- 29 g of lung in supine and prone position, respectively [p < 0.05 vs. 0]), whereas recruitment induced by posture was not statistically significant (77 +/- 97 g with positive end-expiratory pressure 0 and 13 +/- 19 g with positive end-expiratory pressure 10 [p > 0.05 vs. 0]). Regardless the posture, positive end-expiratory pressure redistributed both perfusion and ventilation toward dependent regions. Recruitment by positive end-expiratory pressure was restricted to dorsal regions in supine position, but extended diffusely along the ventral-to-dorsal dimension in prone position. Prone position was associated with recruitment in dorsal regions with concomitant derecruitment in ventral regions, magnitude of this being reduced by positive end-expiratory pressure. Prone position redistributed ventilation toward dorsal and ventral regions at positive end-expiratory pressure 0 and positive end-expiratory pressure, respectively. Finally, prone position redistributed perfusion toward ventral regions, to an extent amplified by positive end-expiratory pressure.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Positive end-expiratory pressure and posture act synergistically by redistributing lung regional perfusion toward ventral regions, but have antagonistic effects on regional ventilation.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Richard</LastName><ForeName>Jean-Christophe</ForeName><Initials>JC</Initials><AffiliationInfo><Affiliation>Hospices civils de Lyon, Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, Lyon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bregeon</LastName><ForeName>Fabienne</ForeName><Initials>F</Initials></Author><Author ValidYN="Y"><LastName>Costes</LastName><ForeName>Nicolas</ForeName><Initials>N</Initials></Author><Author ValidYN="Y"><LastName>Bars</LastName><ForeName>Didier L E</ForeName><Initials>DL</Initials></Author><Author ValidYN="Y"><LastName>Tourvieille</LastName><ForeName>Christian</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Lavenne</LastName><ForeName>Franck</ForeName><Initials>F</Initials></Author><Author ValidYN="Y"><LastName>Janier</LastName><ForeName>Marc</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Bourdin</LastName><ForeName>Gaël</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Gimenez</LastName><ForeName>Gérard</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Guerin</LastName><ForeName>Claude</ForeName><Initials>C</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Crit Care Med</MedlineTA><NlmUniqueID>0355501</NlmUniqueID><ISSNLinking>0090-3493</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Crit Care Med. 2008 Aug;36(8):2469-71</RefSource><PMID Version="1">18664808</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000818" MajorTopicYN="N">Animals</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001784" MajorTopicYN="N">Blood Gas Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004195" MajorTopicYN="Y">Disease Models, Animal</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006439" MajorTopicYN="Y">Hemodynamics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011175" MajorTopicYN="Y">Positive-Pressure Respiration</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D049268" MajorTopicYN="N">Positron-Emission Tomography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016684" MajorTopicYN="N">Prone Position</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011652" MajorTopicYN="N">Pulmonary Circulation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012119" MajorTopicYN="Y">Respiration</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013552" MajorTopicYN="N">Swine</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2008</Year><Month>7</Month><Day>4</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2008</Year><Month>8</Month><Day>30</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2008</Year><Month>7</Month><Day>4</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">18596639</ArticleId><ArticleId IdType="doi">10.1097/CCM.0b013e31818094a9</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>France</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Rhône-Alpes</li></region><settlement><li>Lyon</li></settlement></list><tree><noCountry><name sortKey="Bars, Didier L E" sort="Bars, Didier L E" uniqKey="Bars D" first="Didier L E" last="Bars">Didier L E. Bars</name><name sortKey="Bourdin, Gael" sort="Bourdin, Gael" uniqKey="Bourdin G" first="Gaël" last="Bourdin">Gaël Bourdin</name><name sortKey="Bregeon, Fabienne" sort="Bregeon, Fabienne" uniqKey="Bregeon F" first="Fabienne" last="Bregeon">Fabienne Bregeon</name><name sortKey="Costes, Nicolas" sort="Costes, Nicolas" uniqKey="Costes N" first="Nicolas" last="Costes">Nicolas Costes</name><name sortKey="Gimenez, Gerard" sort="Gimenez, Gerard" uniqKey="Gimenez G" first="Gérard" last="Gimenez">Gérard Gimenez</name><name sortKey="Guerin, Claude" sort="Guerin, Claude" uniqKey="Guerin C" first="Claude" last="Guerin">Claude Guerin</name><name sortKey="Janier, Marc" sort="Janier, Marc" uniqKey="Janier M" first="Marc" last="Janier">Marc Janier</name><name sortKey="Lavenne, Franck" sort="Lavenne, Franck" uniqKey="Lavenne F" first="Franck" last="Lavenne">Franck Lavenne</name><name sortKey="Tourvieille, Christian" sort="Tourvieille, Christian" uniqKey="Tourvieille C" first="Christian" last="Tourvieille">Christian Tourvieille</name></noCountry><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Richard, Jean Christophe" sort="Richard, Jean Christophe" uniqKey="Richard J" first="Jean-Christophe" last="Richard">Jean-Christophe Richard</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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