Trendelenburg Ventilation in Patients of Acute Respiratory Distress Syndrome with Poor Lung Compliance and Diaphragmatic Dysfunction

BACKGROUND: Patients with acute respiratory distress syndrome (ARDS) are generally ventilated in either 45° head elevation or prone position as they are associated with decreased incidence of ventilator-associated pneumonia and mortality, respectively.(1,2) But in patients with poor lung compliance and super-added diaphragmatic weakness/dysfunction, generating a minimum amount of adequate tidal volume (TV) would be very difficult in propped up/supine/prone position, leading to worsening hypoxia and CO(2) retention. We noticed a sustained increase in TV for patients with poor lung compliance (Cs <15 mL/cm H(2)O) and diaphragmatic dysfunction (bilateral diaphragmatic excursion <1 cm, on spontaneous breaths) when the patients are switched to Trendelenburg position with the same ventilator settings. PATIENTS AND METHODS: A case report with possible explanation for the observed changes has been mentioned. RESULTS: Trendelenburg ventilation delivered more TV than propped up or prone ventilation in patients of ARDS with poor lung compliance and diaphragmatic dysfunction. CONCLUSION: Trendelenburg ventilation increases static lung compliance and delivers more TV when compared to propped up/supine/prone ventilation in patients of ARDS with poor lung compliance and diaphragmatic dysfunction. Although the exact mechanism behind this is not known till now, we formulated few theories that could explain the possible mechanism. HOW TO CITE THIS ARTICLE: Kodamanchili S, Saigal S, Anand A, Panda R, Priyanka TN, Balakrishnan GT, et al. Trendelenburg Ventilation in Patients of Acute Respiratory Distress Syndrome with Poor Lung Compliance and Diaphragmatic Dysfunction. Indian J Crit Care Med 2022;26(3):319–321.