Short-term effects of prone position in chronic obstructive pulmonary disease patients with severe acute hypoxemic and hypercapnic respiratory failure

Intensive Care Med. 2005 Aug;31(8):1128-31. doi: 10.1007/s00134-005-2658-5. Epub 2005 Jul 6.


Objective: To assess the short-term effects of prone positioning (PP) in chronic obstructive pulmonary disease (COPD) patients with severe hypoxemic and hypercapnic respiratory failure requiring invasive mechanical ventilation.

Design and setting: Prospective observational study in the general intensive care unit of a university-affiliated hospital.

Patients: 11 consecutive COPD patients with persistent hypoxemia (PaO2/FIO2 < or = 200 mmHg with FIO2 > or = 0.6) and hypercapnia requiring invasive mechanical ventilation. Patients with adult respiratory distress syndrome or left ventricular failure were excluded. Mean age was 73+/-11 years, mean weight 86+/-31 kg, mean SAPS II 53+/-10, and ICU mortality 36%.

Interventions: Patients were turned every 6 h.

Measurements and results: A response to PP (20% or greater PaO2/FIO2 increase) was noted in 9 (83%) patients. Blood gases were measured in the PP and supine (SP) positions 3 h after each turn, for 36 h, yielding six measurement sets (SP1, PP1, SP2, PP2, SP3, and PP3). PaO2/FIO2 was significantly better in PP: 190+/-26 vs. 113+/-9 mmHg for PP1/SP1, 175+/-22 vs. 135+/-16 mmHg for PP2/SP2, and 199+/-24 vs. 151+/-13 mmHg for PP3/SP3. After PP1 PaO2/FIO2 remained significantly improved, and the PaO2/FIO2 improvement from SP1 to SP2 was linearly related to PaO2/FIO2 during PP1 (r=0.8). The tracheal aspirate volume improved significantly from SP1 to PP1. PaCO2 was not significantly affected by position.

Conclusions: PP was effective in treating severe hypoxemia in COPD patients. The first turn in PP was associated with increased tracheal aspirate.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Blood Gas Analysis
  • Female
  • Humans
  • Hypercapnia / etiology
  • Hypercapnia / therapy
  • Hypoxia / etiology
  • Hypoxia / therapy
  • Intensive Care Units
  • Male
  • Prone Position*
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Respiration, Artificial / methods
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy*
  • Time Factors
  • Treatment Outcome