Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 26 , ISSUE 3 ( March, 2022 ) > List of Articles

View Point

Trendelenburg Ventilation in Patients of Acute Respiratory Distress Syndrome with Poor Lung Compliance and Diaphragmatic Dysfunction

Saiteja Kodamanchili, Saurabh Saigal, TN Priyanka, Gowthaman Thatta Balakrishnan, Pranav Shrivatsav

Keywords : ARDS, Proning, Trendelenburg

Citation Information : Kodamanchili S, Saigal S, Priyanka T, Balakrishnan GT, Shrivatsav P. Trendelenburg Ventilation in Patients of Acute Respiratory Distress Syndrome with Poor Lung Compliance and Diaphragmatic Dysfunction. Indian J Crit Care Med 2022; 26 (3):319-321.

DOI: 10.5005/jp-journals-10071-24127

License: CC BY-NC 4.0

Published Online: 30-03-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Patients with acute respiratory distress syndrome (ARDS) are generally ventilated in either 45° head elevation or prone position as they are associated with decreased incidence of ventilator-associated pneumonia and mortality, respectively.1,2 But in patients with poor lung compliance and super-added diaphragmatic weakness/dysfunction, generating a minimum amount of adequate tidal volume (TV) would be very difficult in propped up/supine/prone position, leading to worsening hypoxia and CO2 retention. We noticed a sustained increase in TV for patients with poor lung compliance (Cs <15 mL/cm H2O) and diaphragmatic dysfunction (bilateral diaphragmatic excursion <1 cm, on spontaneous breaths) when the patients are switched to Trendelenburg position with the same ventilator settings. Patients and methods: A case report with possible explanation for the observed changes has been mentioned. Results: Trendelenburg ventilation delivered more TV than propped up or prone ventilation in patients of ARDS with poor lung compliance and diaphragmatic dysfunction. Conclusion: Trendelenburg ventilation increases static lung compliance and delivers more TV when compared to propped up/supine/prone ventilation in patients of ARDS with poor lung compliance and diaphragmatic dysfunction. Although the exact mechanism behind this is not known till now, we formulated few theories that could explain the possible mechanism.


HTML PDF Share
  1. Güner CK, Kutlutürkan S. Role of head-of-bed elevation in preventing ventilator-associated pneumonia bed elevation and pneumonia. Nurs Crit Care 2021;nicc.12633. DOI: 10.1111/nicc.12633.
  2. Guérin C, Reignier J, Richard J-C, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368(23):2159–2168. DOI: 10.1056/NEJMoa1214103.
  3. Regli A, Habre W, Saudan S, Mamie C, Erb TO, von Ungern-Sternberg BS, et al. Impact of Trendelenburg positioning on functional residual capacity and ventilation homogeneity in anaesthetised children. Anaesthesia 2007;62(5):451–455. DOI: 10.1111/j.1365-2044.2007.05030.x.
  4. Peñuelas O, Keough E, López-Rodríguez L, Carriedo D, Gonçalves G, Barreiro E, et al. Ventilator-induced diaphragm dysfunction: translational mechanisms lead to therapeutical alternatives in the critically ill. Intensive Care Med Exp 2019;7(S1):48. DOI: 10.1186/s40635-019-0259-9.
  5. Gutierrez CJ, Stevens C, Merritt J, Pope C, Tanasescu M, Curtiss G. Trendelenburg chest optimization prolongs spontaneous breathing trials in ventilator-dependent patients with low cervical spinal cord injury. J Rehabil Res Dev 2010;47(3):261. DOI: 10.1682/jrrd.2009.07.0099.
  6. Wadsworth BM, Haines TP, Cornwell PL, Paratz JD. Abdominal binder use in people with spinal cord injuries: a systematic review and meta-analysis. Spinal Cord 2009;47(4):274–285. DOI: 10.1038/sc.2008.126.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.