Effects of changes in trunk inclination on ventilatory efficiency in ARDS patients: quasi-experimental study

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dc.article.number65
dc.catalogadoryvc
dc.contributor.authorBenites, Martín H.
dc.contributor.authorTorres, David
dc.contributor.authorPoblete, Fabián
dc.contributor.authorLabbé, Francisco
dc.contributor.authorBachmann, María C.
dc.contributor.authorRegueira, Tomas E.
dc.contributor.authorSoto, Leonardo
dc.contributor.authorFerre, Andrés
dc.contributor.authorDreyse, Jorge
dc.contributor.authorRetamal Montes, Jaime
dc.date.accessioned2023-10-24T14:11:37Z
dc.date.available2023-10-24T14:11:37Z
dc.date.issued2023
dc.date.updated2023-10-01T00:03:05Z
dc.description.abstractTrunk inclination from semirecumbent head-upright to supine-flat positioning reduces driving pressure and increases respiratory system compliance in patients with acute respiratory distress syndrome (ARDS). These effects are associated with an improved ventilatory ratio and reduction in the partial pressure of carbon dioxide (PaCO2). However, these physiological effects have not been completely studied, and their mechanisms have not yet been elucidated. Therefore, this study aimed to evaluate the effects of a change in trunk inclination from semirecumbent (45°) to supine-flat (10°) on physiological dead space and ventilation distribution in different lung regions. Results: twenty-two ARDS patients on pressure-controlled ventilation underwent three 60-min steps in which trunk inclination was changed from 45° (baseline) to 10° (intervention) and back to 45° (control) in the last step. Tunk inclination from a semirecumbent (45°) to a supine-flat (10°) position resulted in a higher tidal volume [371 (± 76) vs. 433 (± 84) mL (P < 0.001)] and respiratory system compliance [34 (± 10) to 41 (± 12) mL/cmH2O (P < 0.001)]. The CO2 exhaled per minute improved from 191 mL/min (± 34) to 227 mL/min (± 38) (P < 0.001). Accordingly, Bohr’s dead space ratio decreased from 0.49 (± 0.07) to 0.41 (± 0.06) (p < 0.001), and PaCO2 decreased from 43 (± 5) to 36 (± 4) mmHg (p < 0.001). In addition, the impedance ratio, which divides the ventilation activity of the ventral region by the dorsal region ventilation activity in tidal images, dropped from 1.27 (0.83–1.78) to 0.86 (0.51–1.33) (p < 0.001). These results, calculated from functional EIT images, indicated further ventilation activity in the dorsal lung regions. These effects rapidly reversed once the patient was repositioned at 45°. Conclusions: a change in trunk inclination from a semirecumbent (45 degrees) to a supine-flat position (10 degrees) improved Bohr’s dead space ratio and reduced PaCO2 in patients with ARDS. This effect is associated with an increase in tidal volume and respiratory system compliance, along with further favourable impedance ventilation distribution toward the dorsal lung regions. This study highlights the importance of considering trunk inclination as a modifiable determinant of physiological parameters. The angle of trunk inclination is essential information that must be reported in ARDS patients.
dc.fechaingreso.objetodigital2023-10-24
dc.fuente.origenAutoarchivo
dc.identifier.urihttps://doi.org/10.1186/s40635-023-00550-2
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/75167
dc.information.autorucEscuela de medicina ; Benites, Martín H. ; 0000-0001-6366-534X ; 1246778
dc.information.autorucEscuela de medicina ; Bachmann, María C. ; 0000-0002-2006-0591 ; 215825
dc.information.autorucEscuela de medicina ; Retamal Montes, Jaime ; 0000-0002-6817-3659 ; 175147
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final12
dc.pagina.inicio1
dc.revistaIntensive Care Medicine Experimental
dc.rightsacceso abierto
dc.rights.holderEuropean Society of Intensive Care Medicine and Springer Nature Switzerland AG
dc.rights.licenseAttribution 4.0 International (CC BY 4.0)
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectAcute respiratory distress syndrome
dc.subjectBody position
dc.subjectRespiratory dead space
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titleEffects of changes in trunk inclination on ventilatory efficiency in ARDS patients: quasi-experimental study
dc.typeartículo
dc.volumen11
sipa.codpersvinculados1246778
sipa.codpersvinculados215825
sipa.codpersvinculados175147
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