The effect of kinetic positioning on lung function and pulmonary haemodynamics in posttraumatic ARDS: a clinical study

doi:10.1016/0020-1383(94)90185-6

Injury

Volume 25, Issue 1, January 1994, Pages 51-57

https://doi.org/10.1016/0020-1383(94)90185-6 Get rights and content

Abstract

In the treatment of adult respiratory distress syndrome (ARDS) no breakthrough has been achieved so far. In several cases of severe ARDS in multiply injured patients we have seen improvements of lung function by means of continuous body positioning. We therefore compared the effect of kinetic positioning (KIN) on lung function and haemodynamics in ARDS patients with conventional (CON) supine positioning. Pulmonary and systemic haemodynamics were determined on the basis of pulmonary artery catheter measurements. On a daily basis oxygenation ratio ( $PaO_{2} FiO_{2}$ ) and pulmonary shunt ( $Os Ot$ , per cent) were calculated. Extravascular lung water (EVLW, ml/kg BW) was determined by the double indicator thermodilution technique. Twenty-two patients were included: KIN, N = 11, CON, N = 11. Mortality from ARDS in KIN patients was 18.2 per cent (N = 2): in CON patients it was 63.6 per cent (N = 7). The oxygenation ratio ( $PaO_{2} FiO_{2}$ ) increased significantly in KIN patients from 140 + 45 (day 0) to 237 + 40 (P < 0.05) (day 5); in CON patients no improvement was seen (143 + 48 (day 0). 133 + 44 (day 5); n.s. between groups at day 0: P < 0.05 between groups at day 5). Pulmonary shunt decreased significantly from 26.6 + 4 per cent (day 0) to 12.5 + 2 per cent (day 5) (P < 0.05) in KIN patients and was 36.6 + 6 per cent at day 0 and 31.4 + 2 per cent at day 5 in CON patients (P < 0.05 between groups at day 5). In KIN patients EVLW was 11.1 + 2 ml/kg BW at day 0 and 9.4 + 1 ml/kg BW at day 5, and in CON patients it was 12.9 + 2 ml/kg BW at day 0 and 17.4 + 3 ml/kg BW at day 5.

There were no significant changes of systemic haemodynamics between the groups or compared with day 0. In ARDS-patients submitted to body positioning lung function improved significantly compared with patients submitted to conventional supine positioning without causing haemodynamic side effects. Continuous body positioning might be a promising supportive treatment regimen in posttraumatic ARDS.

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Citation Excerpt :
In a prospective randomised study, ventilation in prone position was found to be effective in improving arterial oxygenation and preventing posttraumatic ARDS in comparison to “conventional” supine positioning.2,3 The use of a special bed, which allows for lateral rotation of a patient up to an arc of 60° for prevention of posttraumatic pulmonary complications was described in a retrospective series by Pape et al.,4 who found a statistically significant improvement in oxygenation and a reduced incidence of ARDS (34%) by early use of continuous lateral rotational therapy (CLRT) in comparison to conventional management (74%, p < 0.05). A global reduction in ventilation–perfusion inequality5 and a decrease in pulmonary fluid and lung edema6 were identified as the main physiologic effects of lateral continuous rotation in lung-injured patients.
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On day 5, no significant differences were found in cytokine levels between groups, but a significant decrease in IL-8 (p < 0.01) and TNF-α (p < 0.05) serum levels and an increase in IL-8 BAL levels was found in the CLRT-group, but not for conventionally managed patients. In general cytokine BAL levels tended to be increased in both groups, but more pronounced during CLRT. Daily assessment of the severity of disease (SAPS-II, SOFA) was significantly reduced in the study group on days 2–4 (p < 0.05) in comparison to control group.
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PaperThe effect of kinetic positioning on lung function and pulmonary haemodynamics in posttraumatic ARDS: a clinical study

Abstract

Chest

Chest

Chest

Chest

J. Crit. Care

The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care

J. Trauma

Prevention of deep venous thrombosis in patients with acute spinal cord injuries: use of rotating treatment tables

Neurosurgery

Prospective evaluation of combined high frequency ventilation in posttraumatic patients with adult respiratory distress syndrome refactory to conventional ventilatory management

Crit. Care Med.

Ventilationperfusion distributions in the adult respiratory distress syndrome

Am. Rev. Respir. Dis.

Respiratory gases in the regulation of the pulmonary circulation

Physiol. Rev.

Reversal of terminal acute respiratory failure by low frequency positive pressure ventilation with extracorporeal removal of CO2 (LFPPV-ECCO2)

Trans. Am. Soc. Artif. Mem. Organs

Body position changes redistribute lung computed-tomography density in patients with acute respiratory failure

Anesthesiology

Effect of a rotating bed on the incidence of pulmonary complications in critically ill patients

Crit. Care Med.

Paper
The effect of kinetic positioning on lung function and pulmonary haemodynamics in posttraumatic ARDS: a clinical study

Reversal of terminal acute respiratory failure by low frequency positive pressure ventilation with extracorporeal removal of CO₂ (LFPPV-ECCO₂)