Prone position reverses gravitational distribution of perfusion in dog lungs with oleic acid-induced injury

C. M. Wiener, W. Kirk, R. K. Albert

Research output: Contribution to journalArticle

Abstract

Although oxygenation improves in patients with the adult respiratory distress syndrome and in animals with oleic acid- (OA) induced acute lung injury when they are turned from the supine to the prone position, the mechanism(s) by which this improvement occurs is not known. Several groups have speculated that this improvement results from preferential edema accumulation in the dorsal lung regions and redistribution of perfusion away from these regions when the patients are turned to the prone position. We used radiolabeled microspheres to measure the regional distribution of perfusion (Q̇r) to the dorsal, mid, and ventral lungs of eight dogs in vivo in the supine and prone positions, before and after inducing acute lung injury with OA, and correlated the Q̇r observed after injury with the degree of regional extravascular lung water (EVLWr). Before OA, Q̇r increased along the gravitational gradient when the animals were supine but was more uniformly distributed when they were prone. After OA, q̇r again followed a gravitational gradient when the animals were supine but was preferentially distributed to the nondependent regions when they were prone. EVLWr was similar in all regions, regardless of whether OA was injected when the animals were supine or prone. The gravitational Q̇r gradient is markedly reduced in the prone position, both before and after lung injury. The prone position-induced improvement in oxygenation is not the result of redistribution of Q̇r away from areas in which edema preferentially develops.

Original languageEnglish (US)
Pages (from-to)1386-1392
Number of pages7
JournalJournal of applied physiology
Volume68
Issue number4
DOIs
StatePublished - 1990

Keywords

  • edema
  • lung fluid balance
  • pulmonary circulation

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

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