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EFFECTS OF VERTICAL POSITIONING ON GAS EXCHANGE AND LUNG VOLUMES IN ACUTE RESPIRATORY DISTRESS SYNDROME

Jean-Christophe M. Richard, Salvatore Maurizio Maggiore , Jordi Mancebo, François Lemaire, Bjorn Jonson, Laurent Brochard

ELECTRONIC SUPPLEMENTARY MATERIAL

Correspondence and reprint requests to:

Jean-Christophe M Richard, M.D.; Ph.D.

Medical Intensive Care Unit, UPRES EA 38 30

Rouen University Hospital-Charles Nicolle,

1, rue de Germont

76031 Rouen-France

Tel: (33) 2 32 88 82 61…Fax: (33) 2 32 88 83 14

E-mail address:

Procedure:

Ventilatory parameters and therapeutic interventions were kept strictly unchanged during all evaluation periods.

The following criteria were predefined to interrupt the study protocol if required: desaturation corresponding to a drop of more than 10% of baseline SaO2 value; drop in mean arterial pressure of more than 20% of baseline value or heart rate increase of more than 20 % of baseline value. The procedure was completed in the 16 patients without any relevant clinical problems.

F.S1: Verticalization of the patient: this picture shows a patient in the vertical position, as evaluated in the present study. Note that the so called “vertical position” combines a 45° head and upper body elevation with lower limbs down at 45°.

T.S1: patient characteristics

Patient / Age / Weight / SAPS
II / FIO2 / Vt / Days of ALI / LIS / Cause of ALI / Outcome / Response to V
1 / 62 / 75 / 49 / 1 / 492 / 1 / 3.4 / sepsis / D / R
2 / 44 / 82 / 62 / 0.50 / 491 / 1 / 4 / pneumonia / S / R
3 / 44 / 60 / 53 / 1 / 512 / 1 / 3.4 / aspiration / D / R
4 / 71 / 69 / 103 / 1 / 606 / 1 / sepsis / S / R
5 / 46 / 74 / 59 / 1 / 722 / 2 / 2.7 / pneumonia / S / R
6 / 47 / 72 / 30 / 1 / 510 / 3 / sepsis / D / R
7 / 40 / 85 / 43 / 1 / 582 / 2 / 2.7 / pneumonia / D / R
8 / 66 / 95 / 49 / 0.65 / 552 / 4 / 3.4 / pneumonia and TRALI / S / R
9 / 51 / 90 / 49 / 1 / 820 / 6 / 3.2 / pneumonia and sepsis / D / R
10 / 52 / 56 / 49 / 1 / 557 / 5 / 3.2 / sepsis / D / R
11 / 18 / 80 / 91 / 0.70 / 503 / 3 / 3.2 / pancreatis / S / R
12 / 46 / 85 / 41 / 0.65 / 651 / 9 / 3.4 / sepsis / S / NR
13 / 66 / 70 / 45 / 0.75 / 616 / 2 / 2.7 / aspiration / S / NR
14 / 68 / 85 / 67 / 0.50 / 684 / 4 / 2.7 / aspiration / D / NR
15 / 55 / 65 / 29 / 0.60 / 600 / 2 / 2.7 / pneumonia / S / NR
16 / 74 / 50 / 56 / 0.50 / 551 / 6 / 2.5 / pneumonia / S / NR

Legend: Vt : tidal volume (ml); FIO2: oxygen inspired fraction; MV: mechanical ventilation; ALI: acute lung injury; V: verticalization; S: survivor; D: death; R: responder: NR: non-responder; TRALI: transfusion related acute lung injury.