Prone positioning has been suggested as a means to improve oxygenation in patients with ARDS. The role of prone positioning in patients with severe pulmonary contusion is unclear. We studied the short term effects of prone positioning in trauma patients with severe pulmonary contusion, with mechanical ventilatory support.
We performed a retrospective analysis of 45 severely injured trauma patients with pulmonary contusions requiring various levels of mechanical ventilation that were placed in prone position. Patient records were reviewed for blood gas data in the supine position immediately (within 1 hr) before prone position was done (supine 1), blood gas data in the prone position (prone, at 1 hr), and blood gas data in the supine position for 1 hour after being prone for a time between 6 and 12 hours (supine 2). Data were analyzed for immediate effect of prone positioing and sustained effect ( effect persisted or not even after return to supine position).
The mean age of our patients was 36 ± 12 years with an average injury severity score (ISS) of 30 ± 12. As shown in table 1
Blood gas and ventilator dataPaO2PIPSupine 162 ± 449 ± 5Prone198 ± 16 *p<0.0540 ± 4 *p<0.05Supine 264 ± 3 *p<0.0547 ± 4, we noted a significant improvement in oxygenation with prone positioning. The effect of the prone postioning was sustained albeit in a very limited way (oxygenation was statistically improved between supine 1 and supine 2. We also noted a slight but statistically significant drop in the peak inspiratory pressure (PIP) with prone positioning. Arterial carbon dioxide levels did not change significantly with prone positioning.CONCLUSIONS: Prone positioning seems to be a simple and useful approach to improving oxygenation and reducing peak pressures in mechanically ventilated trauma patients with severe pulmonary contusion. A much more limited improvement in oxygenation seems to be sustained even with return to supine position.
Prone positioning should be considered as one of the first line therapuetic interventions in the management of mechanically ventilated trauma patients with severe pulmonary contusion.
A. Chendrasekhar, None.