tailieunhanh - Báo cáo khoa học: " Prone position in mechanically ventilated patients – the hard or the soft way"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Prone position in mechanically ventilated patients – the hard or the soft way? | Available online http 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 Published online 5 May 2005 This article is online at http content 9 3 253 2005 BioMed Central Ltd Critical Care 2005 9 253-254 DOI cc3534 See related research by Michelet et al. in this issue http content 9 3 R251 Abstract 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 air-cushion beds conventional foam mattresses resulted in a greater increase in IAP which was associated with a decrease in the plasma diappearance rate of indocyanin green PDRICG indicating inadequate hepto-splanchnic function. Lung protective mechanical ventilation with high positive end-expiratory pressure and low tidal volumes has been demonstrated to decrease mortality 1 but it may not always ensure adequate gas exchange in severe acute respiratory distress syndrome ARDS . Although prone positioning has been suggested to be lung protective randomized multicentre trials were unable to demonstrate improved survival in patients with ARDS with prone positioning 2 3 . Prone positioning is increasingly being used to treat patients with ARDS because in 60-70 of these patients prone position improves oxygenation sometimes dramatically 2 . Several mechanisms have been proposed to account for this effect including an increase in end-expiratory .