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Effect of Body Position on Gas Exchange in Patients With Idiopathic Pulmonary Alveolar Proteinosis^*

No Benefit of Prone Positioning

^* From the Institute of Clinical Medicine (Dr. Lin), School of Medicine (Dr. Chang), National Yang-Ming University, Taipei, Taiwan, Republic of China; and the Chest Department (Ms. Chen and Ms. Chang), Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.

Correspondence to: Shi-Chuan Chang, MD, PhD, FCCP, Chest Department, Taipei Veterans General Hospital, No. 201 Section 2, Shih-Pai Rd, Shih-Pai, Taipei 112, Taiwan, Republic of China; e-mail: scchang{at}vghtpe.gov.tw

Background: Prone positioning may improve oxygenation in patients with acute lung injury/ARDS. However, the beneficial effect of prone positioning on gas exchange has never been investigated in patients with diffuse pulmonary infiltrates who breathe spontaneously.

Objective: To evaluate the effect of body position on gas exchange in patients with idiopathic pulmonary alveolar proteinosis (PAP) with special reference to the benefit of prone positioning.

Design: A prospective study.

Setting: Tertiary medical center.

Patients and methods: Eight patients with PAP were studied on 25 occasions using spirometry, body plethysmography, and single-breath diffusing capacity of the lung for carbon monoxide (DLCO). Arterial blood gas levels were measured in the sitting position and in four lying positions randomly while patients breathed room air. To serve as control subjects, 16 age-matched healthy hospital personnel were studied. To evaluate the impact of oxygen therapy on positional effect in gas exchange, arterial blood gas levels were measured in the supine and prone positions in some PAP patients while breathing 40% oxygen.

Results: Normal to varying degrees of restrictive ventilatory defect and gas exchange impairment, as evidenced by DLCO, PaO₂, and alveolar-arterial oxygen pressure difference (P[A-a]O₂), were found in PAP patients. The ventilatory function parameters correlated positively with PaO₂ and negatively with P(A-a)O₂. The values of PaO₂ and P(A-a)O₂ measured in four lying positions showed no significant difference in both PAP patients and healthy control subjects. Furthermore, the differences in PaO₂ and P(A-a)O₂ between measurements made in the supine and prone positions and the ratio of PaO₂ measured in the prone position/PaO₂ measured in the supine position were comparable between PAP patients and healthy control subjects. Arterial blood gas levels showed no significant difference between measurements made in PAP patients in the supine and prone positions while breathing 40% oxygen.

Conclusions: Positional change did not significantly affect gas exchange, and no benefit of prone positioning was found in both PAP patients and healthy control subjects. Further studies are needed to verify the benefit of prone ventilation in patients with diffuse pulmonary disorders who breathe spontaneously.

Key Words: gas exchange • postural effect • prone positioning • pulmonary alveolar proteinosis