Author:
Meli Andrea,Barbeta Viñas Enric,Battaglini Denise,Li Bassi Gianluigi,Yang Hua,Yang Minlan,Bobi Joaquim,Motos Ana,Fernández-Barat Laia,Chiumello Davide,Pelosi Paolo,Torres Antoni
Abstract
Abstract
Patients with mono-lateral pneumonia and severe respiratory failure can be positioned in lateral decubitus, with the healthy lung dependent, to improve ventilation-perfusion coupling. Oxygenation response to this manoeuvre is heterogeneous and derecruitment of dependent lung has not been elucidated. Nine pigs (32.2 ± 1.2 kg) were sedated and mechanically ventilated. Mono-lateral right-sided pneumonia was induced with intrabronchial challenge of Pseudomonas aeruginosa. After 24 h, lungs were recruited and the animals were randomly positioned on right or left side. After 3 h of lateral positioning, the animals were placed supine; another recruitment manoeuvre was performed, and the effects of contralateral decubitus were assessed. Primary outcome was lung ultrasound score (LUS) of the dependent lung after 3-h lateral positioning. LUS of the left non-infected lung worsened while positioned in left-lateral position (from 1.33 ± 1.73 at baseline to 6.78 ± 4.49; p = 0.005). LUS of the right-infected lung improved when placed upward (9.22 ± 2.73 to 6.67 ± 3.24; p = 0.09), but worsened in right-lateral position (7.78 ± 2.86 to 13.33 ± 3.08; p < 0.001). PaO2/FiO2 improved in the left-lateral position (p = 0.005). In an animal model of right-lung pneumonia, left-lateral decubitus improved oxygenation, but collapsed the healthy lung. Right-lateral orientation further collapsed the diseased lung. Our data raise potential clinical concerns for the use of lateral position in mono-lateral pneumonia.
Publisher
Springer Science and Business Media LLC
Reference32 articles.
1. Vincent, J., Rello, J., Masrshall, J., Silva, E. & Anzueto, A. International study of the prevalence and outcomes of infection in intensive care units. JAMA 302, 2323–2329 (2012).
2. Cilloniz, C. et al. Acute respiratory distress syndrome in mechanically-ventilated patients with community-acquired pneumonia. Eur. Respir. J. 52, 1–11 (2018).
3. Hedenstierna, G. Effects of body position on ventilation/perfusion matching. In Anaesthesia, Pain, Intensive Care and Emergency Medicine—A.P.I.C.E (ed. Gullo, A.) 3–15 (Springer, New York, 2004).
4. Hedenstierna, G. et al. Ventilation and perfusion of each lung during differential ventilation with selective PEEP. Anesthesiology 61, 369–376 (1984).
5. Bhuyan, U., Peters, A. M., Gordon, I., Davies, H. & Helms, P. Effects of posture on the distribution of pulmonary ventilation and perfusion in children and adults. Thorax 44, 480–484 (1989).
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