Clinical efficacy of prone position ventilation in the treatment of moderate and severe acute respiratory distress syndrome

Objective To investigate the clinical efficacy and safety of prone position ventilation in the treatment of moderate and severe acute respiratory distress syndrome (ARDS).Methods Eight patients with moderate and severe ARDS after recruitment maneuvers (RM) failure were ventilated on prone position.The changes in hemodynamic and respiratory dynamic variables,blood gases before prone position ventilation,two hour after prone position and one hour after resuming supine position were compared.Complications were observed in the course of the treatment.Results Eight patients were ventilated on prone position for 41 times.There were no Serious complications associated with prone position ventilation.After prone position and resuming supine position,partial pressure of carbon dioxide (PaCO2),alveolar-arterial oxygen tension difference [P(Aa)DO2)] decreased and PaO2/FiO2 increased compared to those before prone position (P ＜0.05),but PaO2/FiO2 after resuming supine position is lower than that after prone position (P ＜0.05).There were no significant difference in peak inspiratory pressure (Ppeak),mean airway pressure (Pmean),plateau airway pressure (Pplat),static pulmonary compliance (Cst),central venous pressure (CVP),mean arterial blood pressure (MAP),PH,dopamine and norepinephrine dosage before and after prone position (F =1.404,2.516,2.297,1.904,2.985,2.043,0.106,0.007,0.045,all P ＞0.05).Conclusions Prone position ventilation is safe and effective,which can improve the oxygenation of moderate and severe ARDS with little influence on hemodynamics and respiratory mechanics. Key words: Acute respiratory distress syndrome;  Prone position ventilation ;  Oxygenation