Regional overdistension during prone positioning in a patient with acute respiratory failure who was ventilated with a low tidal volume: a case report

BACKGROUND: Prone positioning may provide a uniform distribution of transpulmonary pressure and contribute to prevent ventilator-induced lung injury. However, despite moderate positive end-expiratory pressure and low tidal volumes, there is still a risk of regional overdistension. CASE PRESENTATION: A man with refractory hypoxemia was mechanically ventilated with prone positioning. Although prone positioning with a plateau pressure of 18 cmH(2)O and a positive end-expiratory pressure of 8 cmH(2)O promptly improved oxygenation, regional ventilation monitoring using electrical impedance tomography initially detected decreased distribution in the dorsal region but increased in the ventral, suggesting overdistension. CONCLUSIONS: Our experience indicates monitoring regional ventilation distribution is useful for decreasing the risk of overdistension during prone positioning.