ArticleAnesthesiology2020
Positional Therapy and Regional Pulmonary Ventilation.
Article in Anesthesiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 12 citations in OpenAlex.
- Characterization of Global Research Trends and Prospects on Prone Positioning in Respiratory Failure: Bibliometric Analysis.Interactive journal of medical research · 2025Article
- A machine-learning regional clustering approach to understand ventilator-induced lung injury: a proof-of-concept experimental study.Intensive care medicine experimental · 2024Article
- Breath-by-breath comparison of a novel percutaneous phrenic nerve stimulation approach with mechanical ventilation in juvenile pigs: a pilot study.Scientific reports · 2024Article
- Deep learning segmentation and registration-driven lung parenchymal volume and movement CT analysis in prone positioning.PloS one · 2024Article
- Perspective from anesthesiologists on the therapy of critically ill patients with COVID-19.Anesthesiology and perioperative science · 2023Article
- Clinical evaluation of prone position ventilation in the treatment of acute respiratory distress syndrome induced by sepsis.World journal of clinical cases · 2022Article
- Perioperative Pulmonary Atelectasis: Part I. Biology and Mechanisms.Anesthesiology · 2022Review
- Perioperative Pulmonary Atelectasis: Part II. Clinical Implications.Anesthesiology · 2022Review
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Authors and funding
15 authors at 1 institution in 2 countries.
Funding
Abstract
backgroundProne ventilation redistributes lung inflation along the gravitational axis; however, localized, nongravitational effects of body position are less well characterized. The authors hypothesize that positional inflation improvements follow both gravitational and nongravitational distributions. This study is a nonoverlapping reanalysis of previously published large animal data.
methodsFive intubated, mechanically ventilated pigs were imaged before and after lung injury by tracheal injection of hydrochloric acid (2 ml/kg). Computed tomography scans were performed at 5 and 10 cm H2O positive end-expiratory pressure (PEEP) in both prone and supine positions. All paired prone-supine images were digitally aligned to each other. Each unit of lung tissue was assigned to three clusters (K-means) according to positional changes of its density and dimensions. The regional cluster distribution was analyzed. Units of tissue displaying lung recruitment were mapped.
resultsWe characterized three tissue clusters on computed tomography: deflation (increased tissue density and contraction), limited response (stable density and volume), and reinflation (decreased density and expansion). The respective clusters occupied (mean ± SD including all studied conditions) 29.3 ± 12.9%, 47.6 ± 11.4%, and 23.1 ± 8.3% of total lung mass, with similar distributions before and after lung injury. Reinflation was slightly greater at higher PEEP after injury. Larger proportions of the reinflation cluster were contained in the dorsal versus ventral (86.4 ± 8.5% vs. 13.6 ± 8.5%, P < 0.001) and in the caudal versus cranial (63.4 ± 11.2% vs. 36.6 ± 11.2%, P < 0.001) regions of the lung. After injury, prone positioning recruited 64.5 ± 36.7 g of tissue (11.4 ± 6.7% of total lung mass) at lower PEEP, and 49.9 ± 12.9 g (8.9 ± 2.8% of total mass) at higher PEEP; more than 59.0% of this recruitment was caudal.
conclusionsDuring mechanical ventilation, lung reinflation and recruitment by the prone positioning were primarily localized in the dorso-caudal lung. The local effects of positioning in this lung region may determine its clinical efficacy. EDITOR’S PERSPECTIVE:
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