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Retentissement cardiovasculaire du décubitus ventral

Cardiovascular impact of prone positioning

  • Mise au Point / Update
  • Published:
Réanimation

Résumé

Le décubitus ventral (DV) est une stratégie de ventilation qui améliore le pronostic des patients présentant un syndrome de détresse respiratoire (SDRA) sévère. Recrutement alvéolaire et amélioration des rapports ventilation/perfusion sont les principaux mécanismes responsables de l’amélioration de l’oxygénation. Le DV est également à l’origine d’une baisse de la pression de plateau et de la PaCO2, et indirectement d’une limitation de la pression expiratoire positive. Pour toutes ces raisons, le DV permet une amélioration de l’hémodynamique systémique en général et de la fonction ventriculaire droite en particulier, participant probablement à son impact positif sur le pronostic. Cette revue a pour objectif de faire une mise au point sur les effets hémodynamiques du DVau cours du SDRA et de rappeler l’importance de la protection ventriculaire droite qu’il permet.

Abstract

Prone positioning is a ventilatory strategy which improves the prognosis of patients with severe acute respiratory distress syndrome (ARDS). Alveolar recruitment and improvement of the ventilation/perfusion ratio are the main mechanisms responsible for improved oxygenation. Prone positioning is also responsible for a decrease in plateau pressure and PaCO2, and indirectly positive end-expiratory pressure (PEEP) limitation. Altogether, these effects ameliorate systemic hemodynamic status in general and right ventricular function in particular. This article reviews hemodynamic effects of prone positioning during ARDS and re-emphasizes the crucial role of protecting the right ventricle using prone positioning.

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Authors and Affiliations

  1. Assistance publique-hôpitaux de Paris, hôpital universitaire Ambroise-Paré, service de réanimation, section thorax-pathologies vasculaires-abdomen-métabolisme, 9, avenue Charles-de-Gaulle, F-92100, Boulogne-Billancourt, France

    X. Repessé, C. Charron & A. Vieillard-Baron

  2. Faculté de médecine, Paris Île-de-France Ouest, University of Versailles Saint-Quentin-en-Yvelines, F-78280, Saint-Quentin-en-Yvelines, France

    A. Vieillard-Baron

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  1. X. Repessé
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  2. C. Charron
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Correspondence to A. Vieillard-Baron.

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Repessé, X., Charron, C. & Vieillard-Baron, A. Retentissement cardiovasculaire du décubitus ventral. Réanimation 24, 93–97 (2015). https://doi.org/10.1007/s13546-015-1030-1

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  • DOI: https://doi.org/10.1007/s13546-015-1030-1

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