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Effect of Body Position on Ventilation Distribution in Ventilated Preterm Infants

Hough, Judith L. PhD1–4; Johnston, Leanne PhD5; Brauer, Sandy PhD5; Woodgate, Paul FRACP6,7; Schibler, Andreas FJICM, MD1,4

Pediatric Critical Care Medicine: February 2013 - Volume 14 - Issue 2 - p 171–177
doi: 10.1097/PCC.0b013e31826e708a
Neonatal Intensive Care

Rationale: Positioning is considered vital to the maintenance of good lung ventilation by optimizing oxygen transport and gas exchange in ventilated premature infants. Previous studies suggest that the prone position is advantageous; however, no data exist on regional ventilation distribution for this age group.

Objectives: To investigate the effect of body position on regional ventilation distribution in ventilated and nonventilated preterm infants using electrical impedance tomography.

Design: Randomized crossover study design.

Setting: Neonatal ICU.

Patients: A total of 24 ventilated preterm infants were compared with six spontaneously breathing preterm infants.

Interventions: Random assignment of the order of the positions supine, prone, and quarter prone.

Measurements and Main Results: Ventilation distribution was measured with regional impedance amplitudes and global inhomogeneity indices using electrical impedance tomography. In the spontaneously breathing infants, regional impedance amplitudes were increased in the posterior compared with the anterior lung (p < 0.01) and in the right compared with the left lung (p = 0.03). No differences were found in the ventilated infants. Ventilation was more inhomogeneous in the ventilated compared with the healthy infants (p < 0.01). Assessment of temporal regional lung filling showed that the posterior lung filled earlier than the anterior lung in the spontaneously breathing infants (p < 0.02) whereas in the in the ventilated infants the right lung filled before the left lung (p < 0.01).

Conclusions: In contrast to previous studies showing that ventilation is distributed to the nondependent lung in infants and children, this study shows that gravity has little effect on regional ventilation distribution.

1 Critical Care of the Newborn Program, Mater Medical Research Institute, South Brisbane, QLD, Australia.

2 School of Physiotherapy, Australian Catholic University, Banyo, QLD, Australia.

3 Department of Physiotherapy, Mater Health Services, South Brisbane, QLD, Australia.

4 Paediatric Critical Care Research Group (JLH, AS), Mater Health Services, South Brisbane, QLD, Australia.

5 School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia.

6 Department of Neonatology, Mater Mothers Hospital, South Brisbane, QLD, Australia.

7 School of Medicine, Griffith University, Gold Coast, QLD, Australia.

Supported, in part, by JP Kelly Research Fund and Olivia’s Lunch in partnership with The Mater Foundation.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article E-mail: judith.hough@mater.org.au

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies