The usual loss of alveoli is minimal in a healthy individual, so the anatomic dead space is?9/25/2023 ![]() ![]() In 1974, Charles Bryan was the first to propose, on a theoretical basis, to keep in “serious consideration” the use of prone position to improve ventilation of the dorsal lung regions. In less severe ARDS, in spite of a better gas exchange, reduced mechanical stress and strain, and improved oxygenation, prone position was ineffective on outcome. The PROSEVA trial finally showed the benefits of prone position on mortality supporting the thesis that the clinical advantages of prone position, instead of improved gas exchange, were mainly due to a less harmful mechanical ventilation and better distribution of stress and strain. However, the first studies provided signals that some survival advantages were possible in a more severe ARDS, where both oxygenation and lung mechanics were impaired. The equations better oxygenation = better survival was disproved by these and other larger trials (ARMA trial). The first two clinical trials in 20 were based on the hypothesis that better oxygenation would lead to a better survival and the studies were more focused on gas exchange than on lung mechanics. The number of clinical studies paralleled the evolution of the pathophysiological understanding. ![]()
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