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Mechanical ventilation for patients with lung damage don't always work as planned
Date:11/12/2009

tter than patients ventilated while they were supine (lying on their backs), as is the standard approach. As in other studies of this physiological-based treatment, blood oxygen levels increased in the prone treatment group. But in the end, the mortality rate among these patients was not statistically different from that of the control group.

In his editorial, Dr. Slutsky asks the following question: "Today, 35 years after prone ventilation was suggested and after hundreds of articles have been published, including more than 150 review articles and more than 10 meta-analyses, why are more definitive conclusions about prone ventilation not available?"

Unfortunately, he says, very few large companies have a commercial interest in this type of interventionfor example, changing a ventilated patient from a supine to a prone position. This explains why funding for such research is hard to obtain and why clear answers about the usefulness of physiological interventions are often lacking.

In this regard, prone ventilation is similar to other physiologically-based interventions for which the effect on important clinical outcomes has not been conclusively proven. In some cases, these physiological "fixes" do not always work as plannedinterventions that improve one physiological value may actually worsen another.

In his editorial, Dr. Slutsky says that basing treatments strictly on physiological endpointsin this case, increasing oxygenation in the blood by mechanically increasing volumes of air in the lungs and changing patients' position during treatmentis "seductive" for several reasons:

  • In many ways, the intensive care unit is a physiology laboratory in which patients' vital signs and other functions are monitored and treated around the clock, seven days a week. By explaining why a patient has a physiological abnormality such as a decrease in oxygenation or worsening kidney function, these measurements can suggest the
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Contact: Julie Saccone
sacconej@smh.toronto.on.ca
416-864-5047
St. Michael's Hospital
Source:Eurekalert

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