Lung recruitment in the prone position after cardiac surgery: a randomised controlled study

• DOI: 10.1016/j.bja.2020.12.039
• Publication Date: 2021-02-16T13:24:02Z
• Authors: Andreas Martinsson; Erik Houltz; Andreas Wallinder; Sophie Lindgren; Anders Thorén
• Keywords: Supine position; Atelectasis; Prone position

BackgroundAtelectasis after cardiac surgery is common and promotes ventilation/perfusion mismatch, infection, delayed discharge from critical care. Recruitment manoeuvres are often performed to reduce atelectasis. In severe respiratory failure, recruitment in the prone position may increase oxygenation, survival, or both. We compared effects of vs supine on lung aeration oxygenation surgical patients.MethodsSubjects were randomised (40 cm H2O peak inspiratory pressure 20 PEEP for 30 s) either uncomplicated surgery. The co-primary endpoints (end-expiratory volume measured by electrical impedance tomography (arbitrary units [a.u.]) (ratio arterial oxygen partial fractional inspired [Pao2/FiO2 ratio]). Secondary outcomes included postoperative requirement adverse events.ResultsThirty subjects (27% female; age, 48–81 yr) recruited. Dorsal tidal was higher (363 a.u.; 95% confidence intervals [CI], 283–443; n=15) extubation, with (212 CI, 170–254; n=15; P<0.001). Prone increased dorsal end-expiratory 724 a.u. (95% 456–992) 163 decrease 73–252) (P<0.001). Pao2/FiO2 ratio extubation (46.6; 40.7–53.0) (39.3; 34.8–43.8; P=0.04). Oxygen therapy shorter (33 h [13]) (52 [22]; P=0.01). No events occurred.ConclusionsRecruitment improve oxygenation.Clinical trial registrationNCT03009331.