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Prone position improves expiratory airway mechanics in severe chronic bronchitis

¹ University of Athens Medical School, Dept of Intensive Care Medicine, Attikon University Hospital, and ² University of Athens Medical School, Dept of Intensive Care Medicine, Evaggelismos General Hospital, Athens, Greece

CORRESPONDENCE: S. D. Mentzelopoulos, 12 Ioustinianou Street, GR-11473, Athens, Greece. Fax: 30 2103218493. E-mail: sdm@hol.gr

Keywords: Air flow, airway resistance, chronic obstructive pulmonary disease, compliance, mechanical ventilation

Received: August 12, 2004
Accepted September 30, 2004

Based on lung parenchyma-airways' interdependence, the present authors hypothesised that prone positioning may reduce airway resistance in severe chronic bronchitis.

A total of 10 anaesthetised/mechanically ventilated patients were enrolled. Partitioned respiratory system (RS) mechanics during iso-flow experiments (flow = 0.91 L·s^–1, tidal volume (V_T) varied within 0.2–1.2 L), haemodynamics, gas-exchange, expiratory airway resistance (R_aw,exp), functional residual capacity (FRC), change in FRC (FRC), end-expiratory lung volume (EELV), expiratory airway resistance at EELV (R_aw,exp,EELV), intrinsic positive end-expiratory pressure (PEEPi), and mean end-expiratory flow were determined in baseline semirecumbent (SR_BAS), prone, and post-prone semirecumbent (SR_PP) postures.

Pronation versus SR_BAS resulted in significantly reduced R_aw,exp (at V_T 0.8 L), R_aw,exp,EELV (18.3±1.4 versus 31.6±2.6 cm H₂O·L^–1·s^–1), inspiratory airway resistance (at V_T 1.0 L), static lung elastance (at V_T 0.6 L), "additional" RS/lung resistance (at a range of V_Ts), FRC (0.35±0.03 versus 0.47±0.03 L), EELV (4.92±0.49 versus 5.65±0.65 L), RS/lung PEEPi (6.7±1.1/5.4±0.6 versus 8.9±1.7/7.8±1.1 cm H₂O), mean end-expiratory flow (63.9±4.2 versus 47.9±4.0 mL·s^–1), and shunt fraction (0.16±0.03 versus 0.21±0.03); benefits were reversed in SR_PP.

In severe chronic bronchitis, prone positioning reduces airway resistance and dynamic hyperinflation.

This article has been cited by other articles:

				S. D. Mentzelopoulos, J. Sigala, C. Roussos, and S. G. Zakynthinos Static pressure-volume curves and body posture in severe chronic bronchitis Eur. Respir. J., July 1, 2006; 28(1): 165 - 174. [Abstract] [Full Text] [PDF]