Prone positioning, systemic hemodynamics, hepatic indocyanine green kinetics, and gastric intramucosal energy balance in patients with acute lung injury

Objective: To investigate the effects of prone positioning on systemic hemodynamics, intra-abdominal pressure (IAP), plasma disappearance rate of indocyanine green (PDRICG), and gastric intramucosal to arterial PCO2 difference (Pi-aCO(2)). Design and setting: Prospective randomized study in the intensive care unit of a university hospital. Patients: 12 mechanically ventilated, hemodynamically stable patients with acute lung injury. Intervention: Positioning supine and prone for 3 h in random order. Measurements: Systemic hemodynamics were determined by transpulmonary double-indicator dilution technique using an integrating fiberoptic monitoring system. The same monitoring system was used to measure PDRICG. IAP was measured in the urinary bladder and gastric intramucosal PCO2 was evaluated by automated recirculation gas tonometry. Results: IAP increased from 10 +/- 3 in the supine to 13 +/- 4 mmHg in the prone position. Cardiac index increased from 3.8 +/- 0.9 (supine) to 4.2 +/- 0.6 l/m(2) per minute (prone), mean arterial pressure from 75 10 (supine) to 81 +/- 11 mmHg (prone), PaO2/FIO2, from 194 +/- 66 (supine) to 269 +/- 68 mmHg (prone), and oxygen delivery from 558 +/- 122 (supine) to 620 +/- 74 ml/m(2) per minute (prone). No other parameters, including PDRICG and Pi-aCO(2), differed between the two positions. Conclusions: Prone positioning in mechanically ventilated patients with acute lung injury, despite a small increase in IAP, does not negatively affect the hepatic capacity to eliminate ICG and gastric intramucosal energy balance when systemic blood flow and oxygenation are improved.