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Prone Positioning ventilation’s effect on abdominal organs: A clinical imaging study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care, Hedenstierna laboratory.ORCID iD: 0000-0003-4791-4507
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.ORCID iD: 0000-0003-2955-4958
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care, Hedenstierna laboratory.ORCID iD: 0000-0002-2923-6012
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Prone positioning is part of the management of acute respiratory distress syndrome (ARDS). During the pandemic of SARS-CoV-2, the use of prone positioning ventilation increased dramatically. However, the effect of the pronation on other organs than the lungs has not been widely studied. 

This study aimed to compare abdominal edema, perfusion and inflammation in supine and prone positioning in an endotoxemic porcine model.

Methods: Sixteen piglets were randomized into two groups: a supine group (n = 8) and a Prone group (n = 8) Both groups received endotoxemic infusion and were observed for 6 hours. Hemodynamic, respiratory parameters were recorded and blood samples for blood gas analysis and cytokine (TNFa, IL6, IL1b) concentration measurement were performed at baseline and every hour. Three animals per group underwent magnetic resonance imaging (MRI) for imaging acquisition. Post-mortem samples of abdominal organs and lung tissue were collected for cytokine concentration measurements, histopathological analysis and wet-dry ratio.

Results: The prone group had a faster CO2 washout and needed a lower positive end-expiratory pressure to maintain the desired oxygenation. Edema was higher in the duodenum (wet-dry ratio – median; range: supine group 1.47; 1.15-3.1 gr. Prone group 1.57; 1.2-2.9 gr. p value 0.04) and average perfusion was lower in kidneys (supine group: 0.13; prone group 0.03. p value 0.05) in the prone group. In addition, the histopathological samples of the kidneys showed a higher incidence and extent of glomerular thrombosis.

Conclusions: The presented model showed that prone positioning was associated with a lower kidney perfusion and glomerular thrombosis.

Keywords [en]
mechanical ventilation, prone position, abdominal organs, diffusion weighted imaging
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-480968OAI: oai:DiVA.org:uu-480968DiVA, id: diva2:1684611
Funder
Uppsala UniversityAvailable from: 2022-07-27 Created: 2022-07-27 Last updated: 2022-07-28Bibliographically approved
In thesis
1. The effect of mechanical ventilation on the abdominal organs
Open this publication in new window or tab >>The effect of mechanical ventilation on the abdominal organs
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During mechanical ventilation (MV), the interplay between abdomen and thorax has been studied unilaterally focusing on the effect that an increased abdominal pressure would have on the thorax. Only a small cluster of studies offered a different perspective showing a lower inflammation and a better lymphatic clearance of edema in abdominal organs when spontaneous breathing was applied compared to MV. Apart from these insights, a deeper understanding of the effect of different MV features on the abdominal organs remains uninvestigated.The aims of the thesis were: to investigate how changes in perfusion and edema influence inflammation and affect each other, and to examine how the management of ARDS could affect abdominal organs by comparing MV with spontaneous breathing and prone with supine position. All the studies were conducted using a porcine model. In three studies, a septic-like status was generated with an infusion of endotoxin; while in one study, a VILI model was used to simulate ARDS.In the first two studies, perfusion and lymphatic drainage were modified in different groups of animals and the impact of the changes on the abdominal organs was assessed. In the other two studies the effect of different ventilation settings on the abdominal organs was investigated: in Paper III, spontaneous breathing(CPAP) was compared with MV (maintaining positive end expiratory pressure – PEEP – and respiratory rate similar in both groups), and, in Paper IV, MV in prone position was compared with MV in supine position. The main findings were that low perfusion increased inflammation in the abdominal organs, but the hemodynamic parameters could not affect intestinal perfusion or edema. Similarly, increased edema was not associated with a decreased perfusion, but it enhanced inflammation in duodenum. MV increased systemic inflammation compared to CPAP, but did not increased inflammation or edema in the abdominal organs. Prone position reduced renal perfusion and was associated to extensive renal micro-thrombosis. In conclusion, both perfusion and edema influence inflammation in the abdomen, even if they seem not to affect one another. Besides, spontaneous breathing develops less systemic inflammation compared to MV, but it was not associated to a lower edema or inflammation in the abdomen; on the other side, prone positioning resulted in a possibly dangerous decrease of renal perfusion.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2022. p. 94
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1858
Keywords
Mechanical ventilation, abdominal organs, diffusion weighted imaging, magnetic resonance, perfusion, edema, inflammation
National Category
Anesthesiology and Intensive Care Radiology, Nuclear Medicine and Medical Imaging
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-480969 (URN)978-91-513-1570-6 (ISBN)
Public defence
2022-09-30, Nórlensalen, Ingång 100, Akademiska Sjukhuset, Uppsala, 09:00 (English)
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Supervisors
Funder
Uppsala University
Available from: 2022-09-08 Created: 2022-07-27 Last updated: 2022-09-09

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Marchesi, SilviaLundström, ElinHedenstierna, GöranLarsson, AndersLarsson, AndersAhlström, HåkanLipcsey, Miklós

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