Effect of Prone Positoning (PP) on Right Ventricle in ARDS !
Prone position in ARDS though remains very fascinating in theory but remain very hard to deliver clinically due to logistics issue. Dangers of losing tube, IVs and overwhelming need of staff are various factors of its unpopularity. Specifically developed prone beds (like Rotoprone) are available but still not widely used due to cost and various reasons as above.
One interesting aspect of prone therapy is its benefit in acute cor pulmonale which may develops in severe ARDS patients. One recently published study from france looked into effect of prone positioning into unloading of the right ventricle in Severe ARDS.
42 ARDS patients treated by PP to correct severe oxygenation impairment (P/F ratio, less than 100 mm Hg).
- 21 patients had acute cor pulmonale (defined by RV enlargement associated with septal dyskinesia),
- 21 patients had a normal RV.
RV function was evaluated by bedside transesophageal echocardiography, before and after 18 hours of prone position ventilation.
- PP was accompanied by a significant decrease in airway pressure and PaCO2 in both groups
- In cor pulmonale group, PP produced a significant decrease in mean RV enlargement after 18 h of PP and a significant reduction in mean septal dyskinesia after 18 h of PP
In the most severe forms of ARDS, PP was an efficient means of controlling RV pressure overload.
Reference: click to get abstract
Prone Positioning Unloads the Right Ventricle in Severe ARDS - Chest.2007; 132: 1440-1446