Adhikari, NKJ, McAndrews MP, Tansey CM (2009) Self-reported symptoms of depression and memory dysfunction in survivors of ARDS. Chest, 135, 678-87
www.chestjournal.org/content/135/3/678.abstract
• ARDS survivors report a high prevalence of depression and a lower prevalence of memory dysfunction 6 to 48 months after ICU discharge; these may hinder the return to work

Albert RK (2000) Prone ventilation. Clin Chest Med, 21, 511-19
• mechanism and effects of proning

Atabai K (2002) The pulmonary physician in critical care. 5: acute lung injury and ARDS. Thorax, 57, 452-8

Baktoft B (2001) Nursing care of patients in the prone position. Crit Care Nurs Eur, 1, 83-6
• lots of practical information

Ball C, Adams J, Boyce S, Robinson P (2001) Clinical guidelines for the use of the prone position in ARDS. Int Crit Care Nurs, 17, 94-104
• flow chart and practicalities

Barker M, Adams S (2002) An evaluation of a single chest physiotherapy treatment on mechanically ventilated patients with acute lung injury. Physiother Res Int, 7, 3, 157-69
www3.interscience.wiley.com/journal/112501201/abstract
• PaO2:FiO2 ratio did not alter significantly with (a) suction, (b) positioning and suction, (c) positioning, MH and suction.

Bigatello LM, Hess, DR (2002) Lung recruitment: the role of recruitment maneuvers. Respir Care, 47, 308-17
www.rcjournal.com/contents/03.02/03.02.0308.asp
• the low tidal volume ventilation which protects ARDS lungs may cause alveolar de-recruitment, but this can be modified by open-lung recruitment strategies e.g. increased PEEP, sustained inflation manoeuvers, sigh breaths and spontaneous breathing.

Borges JB et al (2006) Reversibility of lung collapse and hypoxemia in early ARDS. Am J Respir Crit Care Med, 174, 268-78
• stepwise maximum-recruitment strategy using CT and continuous blood-gas haemodynamic monitoring

Carr J (2007) Psychological consequences associated with intensive care treatment. Trauma, 9, 95–102
• 70% of patients with sepsis suffer encephalopathy
Cereda (1996) Positive end-expiratory pressure prevents loss of respiratory compliance with low tidal volume ventilation. Chest, 109, 480-85
• 15 cmH2O PEEP prevents loss of lung compliance associated with low-volume IPPV

Colmenero-Ruiz M (2001) Abdomen release in prone position does not improve oxygenation in an experimental model of acute lung injury. Int Care Med, 27, 566-73
• prone with a free abdomen does not improve gas exchange - but this may not apply to humans which are different to pigs

Coombes H (2001) The prone position for IPPV. ACPRC Journal, 34, 29-38
• practicalities

Cranshaw J, Griffiths MJD (2002) The pulmonary physician in critical care: non-ventilatory strategies in ARDS. Thorax, 57, 823-9
• fluids, drugs, immunonutrition, surfactant, antioxidants

de Molina FG, Ferrer R (2011) Appropriate antibiotic dosing in severe sepsis and acute renal failure: factors to consider. Crit Care, 15, 175
ccforum.com/content/15/4/175/abstract

Duan M, Lorenzo B, Ashees K (2011) Use of hypothermia to allow low-tidal-volume ventilation in a patient with ARDS. Respir Care, 56, 12, 1956-8
• mild hypothermia allows very low-tidal volume ventilation

Dyhr T (2002) Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in ARDS. Crit Care, 7, 55-62
• alveoli re-opened after suction by hyperinflation using CPAP ventilator function at 45 cmH2O for 20 secs

Eisner MD (2002) Airway pressures and early barotrauma in patients with acute lung injury and ARDS. Am J Respir Crit Care Med, 165, 978-82

Goettler CE (2002) Brachial plexopathy after prone positioning. Crit Care, 6, 540-2
• mechanisms, prevention

Hemmila MR, Rowe SA, Boules TN et al (2004) Extracorporeal life support for severe acute respiratory distress syndrome in adults. Annals of Surgery, 240, 595–607.
www.ncbi.nlm.nih.gov/pmc/articles/PMC1356461/
• ECMO for severe ARDS in adults is a successful treatment for patients who do not respond to conventional mechanical ventilation

Herridge MS, Tansey CM, Matté A (2011) Functional disability 5 years after Acute Respiratory Distress Syndrome. N Engl J Med, 364, 1293-1304
• Survivors of severe lung injury often have normal lung function but tend to show reduced exercise tolerance and other physical and psychological sequelae.

Kacmarek RM et al (2006) Partial liquid ventilation in adult patients with ARDS. Am J Respir Crit Care Med, 173, 882-9
• ajrccm.atsjournals.org/content/vol173/issue8/index.shtml

Kallet R (2004) Evidence-based management of acute lung injury and ARDS. Respir Care, 49, 793-809
www.rcjournal.com/contents/07.04/07.04.0793.pdf
• 15 therapies reviewed

Kallet RH (2001) Lung collapse during low tidal volume ventilation in ARDS. Respir Care, 46, 49-52
• importance of pulmonary hygiene during lung-protective ventilation

Khan A (2010) Recruitment maneuvers in ARDS... more questions than answers. Chest, 137, 3, 737

Lee WL, Detsky AS, Stewart TE (2000) Lung-protective mechanical ventilation strategies in ARDS. Int Care Med, 26, 1151-5
• review article on IPPV for ARDS

L’Her E et al (2002) A prospective survey of early 12-hour positioning effects in patients with ARDS. Int Care Med, 28, 570-5
• 12-hour proning beneficial and safe

Lim C-M, Koh Y, Chin JY (1999) Respiratory and haemodynamic effects of the prone position. Eur Resp J, 13, 163-8
• prone increases SaO2 in two-thirds of patients, and reduces the need for PEEP

Lindén V (2000) High survival in adult patients with ARDS treated by ECMO, minimal sedation and pressure supported ventilation. Int Care Med, 26, 1630-7

Maggiore SM (2003) Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. Am Rev Resp Crit Care Med, 167, 1215-24.
• suction-induced atelectasis in acute lung injury can be prevented by a recruitment manoeuvre (pressure support at 40 cm H2O) during suction, and minimized by avoiding disconnection

Mancebo J (2006) A multicenter trial of prolonged prone ventilation in severe ARDS. Am J Respi.Crit.Care Med, 173, 1233-9
ajrccm.atsjournals.org/cgi/content/abstract/173/11/1233
• at last someone brave enough to prone their patients early enough and long enough

Martin GS, Bernard GR (2001) Airway and lung in sepsis. Int Care Med, 27, S63-79
• pathology and management

Martin JB, Wheeler AP (2009) Approach to the patient with sepsis. Clin Chest Med, 30, 1, 1-16
www.chestmed.theclinics.com/article/S0272-5231%2808%2900093-2/abstract

Medoff BD (2000) Use of recruitment maneuvers and high PEEP in a patient with ARDS. Crit Care Med, 28, 1210-16

Messerole E et al (2002) The pragmatics of prone positioning. Am J Resp Crit Care Med, 165, 1359-63
• succint explanation of the rationale of proning in ARDS + useful algorithm on the procedure

Moloney ED, Griffiths MJD (2004) Protective ventilation of patients with acute respiratory distress syndrome. Br J Anaesth, 92, 261–70
www.bja.oupjournals.org/cgi/content/abstract/92/2/261
• mechanism of inflammatory response to injured and overdistended lung, and prevention

Mols G, Priebe HJ, Guttmann J (2006) Alveolar recruitment in acute lung injury. Br J Anaesth, 96 (2), 156-66
bja.oxfordjournals.org/cgi/content/full/96/2/156?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=96&firstpage=156&resourcetype=HWCIT
• clear and balanced explanation of alveolar recruitment

Morán I (2006) Heat and moisture exchangers and heated humidifiers in ALI/ARDS patients. Int Care Med, 32, 4, 524-31
springerlink.metapress.com/(4nt0hn55kegoqri5o1po2rub)/app/home/contribution.asp?referrer=parent&backto=issue,7,37;journal,4,297;browsepublicationsresults,615,1574
• heated humidifier reduces dead space and decreases PaCO2 so that tidal volume can be lowered, which improves respiratory system compliance and reduces plateau airway pressure

Offner PJ (2000) Complications of prone ventilation with multisystem trauma and ARDS. J Trauma Injury Inf Crit Care, 48, 224-8

Reinprecht A (2003) Prone position in subarachnoid hemorrhage patients with ARDS. Crit Care Med, 31, 1831-8
www.ccmjournal.com/pt/re/ccm/abstract.00003246-200306000-00035.htm;jsessionid=B3TX8YDpQ8YVR84FciQAcCJECdeIp6YMprEWPU5UsmW709cqKzPr!113108930!-949856032!9001!-1
• beneficial effect of prone outweighs the expected adverse effects

Rialp G, Betbesé AJ, Ormaechea E (1997) Changes in pulmonary mechanics with change from supine to prone in ARDS. Int Care Med, 23, S12
• prone position recruits lung volume by 57%

Rocker GM, Mackenzie M-G (1999) Noninvasive positive pressure ventilation: successful outcome in patients with ALI/ARDS. Chest, 115, 173-7
• non-invasive ventilation should be considered in the early stages

Rowe C (2004) Development of clinical guidelines for prone positioning in critically ill adults. Nurs Crit Care, 9, 50-57
• everything you need to know about the practicalities

Rylander C (2005) Uneven distribution of ventilation in acute respiratory distress syndrome. Crit.Care, 9, R165-R171
ccforum.com/content/9/2/R165/abstract
• about one-third of the gas volume is delivered to poorly ventilated or non-ventilated areas

Schelling G (1998) Health-related quality of life and posttraumatic stress disorder in survivors of ARDS. Crit.Care Med, 26, 651-9
• PTSD found in 27% of survivors, due to traumatic experiences in the ICU

Schweiger JW (2003) Chest wall disruption with and without acute lung injury: effects of CPAP on ventilation and perfusion. Crit Care Med, 31, 2364-70
www.ccmjournal.com/pt/re/ccm/abstract.00003246-200309000-00015.htm;jsessionid=B3RZ2d1yq8PXHNsgatN3i5Cx1YF26wQBAM6fe0Z2orGsHLbP6BOM!113108930!-949856032!9001!-1
• CPAP reduces shunt

Sheu CC (2010) Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS. Chest, 138, 3 559-67
chestjournal.chestpubs.org/content/138/3/559.full
• sepsis-related ARDS associated with higher mortality than non-sepsis-related ARDS

Silva S, Teboul JL (2011) Defining the adequate arterial pressure target during septic shock: not a 'micro' issue but the microcirculation can help. Crit Care,15, 6, 100
ccforum.com/content/15/6/1004/abstract
• maintain mean arterial pressure of at least 65 mmHg to maintain organ perfusion

Suter PM (2000) Let us recruit the lung and keep an open mind. Int Care Med, 26, 491-2
• narrow path between sufficient distending pressure and avoidance of ventilator-induced lung injury

Thees C, Kaiser M, Scholz M (2007) Cerebral haemodynamics and carbon dioxide reactivity during sepsis syndrome. Crit Care, 11, R123
ccforum.com/content/11/6/R123
• most patients with sepsis develop potentially irreversible cerebral dysfunction

Venet C (2001) The oxygenation variations related to prone positioning. Int Care Med, 27, 1352-9
• prone improves oxygenation in 90% of patients with ARDS and non-ARDS hypoxaemic patients

Villagra A (2002) Recruitment maneuvers during lung protective ventilation in ARDS. Am J Respir Crit Care Med, 165, 165-70
• 2 mins of ventilator-delivered peak pressures at 50 cmH20 shows no benefit and may cause overdistension

Ware LB (2000) The acute respiratory distress syndrome. New Eng J Med, 342, 1344-8
• detailed pathology, medical management

Wong WP (1999) Use of body positioning in the mechanically ventilated patient with acute respiratory failure. Physiother.Theory Pract, 15, 25-41
journalsonline.tandf.co.uk/(bz4jexmgk1nprw45mbknvpzm)/app/home/journal.asp?referrer=parent&backto=browsepublicationsresults,998,1278
• prone: increases PaO2 2.7-6.2 kPa, increases PaO2:FIO2 ratio 6.7-13.3 kPa, clears lung densities on CT scan, increases normal VA/Q 12%, reduces shunt 11%


ACPRC = Association of Chartered Physiotherapists in Respiratory Care
ALI – acute lung injury (sometimes a precursor to the more serious ARDS)
ARDS = acute respiratory distress syndrome
IPPV = intermittent positive pressure ventilation, i.e. mechanical ventilation
MH = manual hyperinflation
PaO2:FIO2 = ratio of PaO2 to inspired oxygen
PEEP = positive end-expiratory pressure
PTSD = posttraumatic stress disorder
VA/Q = ventilation-perfusion ratio


(updated 29/11/10)