Prone position improves mechanics and alveolar ventilation in acute respiratory distress syndrome

Objective: We tested the hypothesis that ventilation in the prone position might improve homogenization of tidal ventilation by reducing time-constant inequalities, and thus improving alveolar ventilation. We have recently reported in ARDS patients that these inequalities are responsible for the presence of a "slow compartment," excluded from tidal ventilation at supportive respiratory rate. Design: In 11 ARDS patients treated by ventilation in the prone position because of a major oxygenation impairment (PaO2/FIO(2)less than or equal to100 mm Hg) we studied mechanical and blood gas changes produced by a low PEEP (6+/-1 cm H2O), ventilation in the prone position, and the two combined. Results: Ventilation in the prone position significantly reduced the expiratory time constant from 1.98+/-0.53 s at baseline with ZEEP to 1.53+/-0.34 s, and significantly decreased PaCO2 from 55+/-11 mm Hg at baseline with ZEEP to 50+/-7 mm Hg. This improvement in alveolar ventilation was accompanied by a significant improvement in respiratory system mechanics, and in arterial oxygenation, the latter being markedly increased by application of a low PEEP (PaO2/FIO2 increasing from 64+/-19 mm Hg in supine position with ZEEP to 137+/-88 mm Hg in prone with a low PEEP). Conclusion: In severely hypoxemic patients, prone position was able to improve alveolar ventilation significantly by reducing the expiratory time constant.