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Comparison of Intra-Abdominal Pressure Among 3 Prone Positional Apparatuses After Changing From the Supine to the Prone Position and Applying Positive End-Expiratory Pressure in Healthy Euvolemic Patients: A Prospective Observational Study.
Kim, Eugene MD; Kim, Hyun-Chang MD; Lim, Young-Jin MD, PhD; Kim, Chi-Heon MD, PhD; Sohn, Seil MD; Chung, Chun-Kee MD, PhD; Kim, Hyoung-Jun MD; Kang, Hyun MD, PhD; Park, Hee-Pyoung MD, PhD
[Article] Journal of Neurosurgical Anesthesiology. 29(1):14-20, January 2017.

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Background: Positional apparatuses used for the prone position can affect intra-abdominal pressure (IAP). In this study, we compared the IAP after changing to the prone position and applying various positive end-expiratory pressure (PEEP) levels among 3 prone positional apparatuses.

Methods: A total of 108 healthy euvolemic patients undergoing elective prone spinal surgery were divided into 3 groups based on the positional apparatus used: the Jackson spinal table was used in group J (n=36), the Wilson frame in group W (n=36), and chest rolls in group C (n=36). The IAP was measured 2 minutes after application of 0, 3, 6, and 9 cm H2O of PEEP.

Results: The IAP in the supine position was 6.4 /-3.0, 5.9 /-2.8, and 7.1 /-2.5 mm Hg in groups J, C, and W, respectively. After the supine-to-prone positional change, the IAP in the prone position was significantly lower in group J than in groups C and W (2.7 /-2.9 vs. 8.9 /-4.0 and 12.9 /-4.3 mm Hg, P<0.01). In the prone position, a PEEP of 9 cm H2O increased the IAP from baseline (zero PEEP) by 1.5 /-1.3, 1.6 /-1.3, and 1.7 /-1.0 mm Hg in groups J, C, and W, respectively.

Conclusions: The IAP in the prone position was significantly lower using the Jackson table compared with the Wilson frame and chest rolls. A PEEP up to 9 cm H2O can be safely used in healthy euvolemic patients undergoing prone spinal surgery without a clinically significant increase in IAP, irrespective of the type of prone positional apparatus.