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

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. A man with refractory hypoxemia was mechanically ventilated with prone positioning. Although prone positioning with a plateau pressure of 18 cmH O and a positive end-expiratory pressure of 8 cmH 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. Our experience indicates monitoring regional ventilation distribution is useful for decreasing the risk of overdistension during prone positioning.