Prone positioning in the acute respiratory distress syndrome [3]

摘要

Guerin et al. remarkably found better outcomes with early prone positioning of patients with severe ARDS. Patients with ARDS who have massive obesity, acute pancreatitis, or any cause of high, intraabdominal pressure and who receive mechanical ventilatory support commonly have an upward shift of the diaphragm and basal atelectasis in the supine position. Placing such patients in the prone position may reopen the collapsed airways and thus improve pulmonary gas exchange and respiratory mechanics. However, it has been suggested that the prone position may increase abdominal pressure if the abdominal wall is not allowed to hang freely. Do the authors have measures of intraabdominal pressure? How did they treat patients with a disease process that may have resulted in elevated abdominal pressures?