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ISSN: 1642-5758
Anaesthesiology Intensive Therapy
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vol. 54
Letter to the Editor

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

Marko Oydanich
Rotem Naftalovich
1, 2
Andrew J. Iskander

  1. Department of Anaesthesia and Perioperative Care, Rutgers – New Jersey Medical School, Newark, NJ, United States
  2. Medical Corps, U.S. Army
  3. Department of Anaesthesiology, Rutgers – Robert Wood Johnson Medical School, New Brunswick, NJ, United States
Anaesthesiol Intensive Ther 2022; 54, 2: 187–189
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.
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