Lic. Kinesiólogo Fisiatra. Especialista en Kinesiologia Respiratoria Crítica de Adultos (Sociedad Argentina de Terapia Intensiva)
Prone position: a measure of lung protection in potential lung donors. Case report
Pablo E Centeno1, Daniel Rodriguez1, Lisandro Sanabria1, Mauricio Petre1, Federico Puzzo1, Roger Canelon1, Luciana Boffino1, Ernesto Montiel1.
1Hospital de Alta Complejidad del Bicentenario de Esteban Echeverría, Buenos Aires, Argentina
Introduction: Cerebral circulatory arrest initiates a proinflammatory cascade that impairs organ function. At the respiratory level, the increase in intravascular pressure damages the alveolar cells and increases vascular permeability. Mechanical ventilation (MV) generates stress and increases the circulation of inflammatory mediators. Respiratory muscle inactivity and supine position predispose to atelectasis, alteration of ventilatory mechanics and gas exchange. The abolition of the cough reflex hinders the hygiene of the airway, generating a risk for the lungs. The inflammation, the drop in oxygenation and the hemodynamic alterations will affect the rest of the organs, reducing their quality or even making them unfeasible for transplantation. Donor ventilation seeks to preserve the lung and reduce the damage caused by MV. There is evidence that demonstrates the benefits of the prone position in patients with Acute Respiratory Distress Syndrome: improvement in gas exchange, increased functional residual capacity, optimization of perfusion, decreased pulmonary stress and mediastinal compression. Considering the difficulty in obtaining lungs for transplantation, the use of the prone position in potential donors would reverse the deleterious effects described, increasing the availability of lungs suitable for donation. The objective of this work is to report the case of a patient to whom the prone position was applied from the diagnosis of BD.
Material and method: Case report type study at the Bicentenario Esteban Echeverría Hospital during March 2022.
Case presentation: Male, 25 years old, with no relevant history, with chronic otitis (45 days). Admitted on guard for tonic-clonic seizures, without subsequent recovery. Glasgow score 3/15. Brain abscess contiguous to the inner ear and generalized edema were identified. Irreversible cessation of brain functions was diagnosed within the first 24 hours of hospitalization. He received antibiotic treatment since admission. On day 1 of MV he had PaO2/FiO2 287 and Crs 46 ml/cmH2O. The prone position was established. On day 2 of MV he had PaO2/FiO2 509 and Crs 63.7 ml/cmH2O (Figure 1). He did not require vasopressor support nor did he present organic dysfunction. After 48 hours of antibiotic treatment, the lungs were distributed.
Conclusion: The change of position from supine to prone improved both the mechanics of the respiratory system and gas exchange. The patient went from meeting marginal criteria to ideal criteria to donate lungs and was accepted for organs distribution, even lungs.
Agradecimiento al Dr. Adrian Tarditti por su labor en el desarrollo de nuestra institución y haciendo posible la realización de dichos trabajos de investigación.
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