Respiratory decompensation with proning – when prone positioning can worsen respiratory mechanics

Marko Oydanich; Rotem Naftalovich; Andrew J. Iskander

doi:10.5114/ait.2022.113730

eISSN: 1731-2531
ISSN: 1642-5758

Anaesthesiology Intensive Therapy

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Letter to the Editor

Respiratory decompensation with proning – when prone positioning can worsen respiratory mechanics

Marko Oydanich

¹

,

Rotem Naftalovich

^{1, 2}

,

Andrew J. Iskander

³

Department of Anaesthesia and Perioperative Care, Rutgers – New Jersey Medical School, Newark, NJ, United States
Medical Corps, U.S. Army
Department of Anaesthesiology, Rutgers – Robert Wood Johnson Medical School, New Brunswick, NJ, United States

Anaesthesiol Intensive Ther 2022; 54, 2: 187–189

DOI: https://doi.org/10.5114/ait.2022.113730

Online publish date: 2022/04/22

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Prone positioning recently gain- ed more popularity from its use in COVID-19 management. It is gene-rally considered to improve respiratory mechanics via increased lung compliance. In surgery, prone positioning is typically encountered when it is a necessity to access certain posterior anatomic structures. Though certain post-operative complications from prone positioning are well known (e.g., postoperative vision loss), the potential intraoperative complications that it can have for respiratory compliance and O2 saturation, in the setting of general anaesthesia, are perhaps less familiar, as only a few studies showed improved respiratory mechanics in the setting of general anaesthesia [1–3] and one study showed that prone positioning led to a 30–35% drop in respiratory compliance under general anaesthesia [4]. As the following case illustrates, proning is a critical point in the intraoperative course as it can sometimes lead to negative respiratory sequelae disrupting homeostasis.

Respiratory decompensation with proning – when prone positioning can worsen respiratory mechanics

Marko Oydanich 1 , Rotem Naftalovich 1, 2 , Andrew J. Iskander 3

Marko Oydanich

¹

,

Rotem Naftalovich

^{1, 2}

,

Andrew J. Iskander

³