Effect of Prone Position Ventilation on Hemodynamics in Patients with Interstitial Lung Disease Concurrent with Acute Respiratory Distress Syndrome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ChenSibei , YuYuheng , LiuDongdong , ZhangJie , YangChun , SangLing , XuYonghao , SunQingwen , NongLingbo , XuYuanda , LiuXiaoqing , LiYimin ,  HeWeiqun

Department of Critical Care Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China;

Corresponding author：

HeWeiqun, Email: heweiqun@126.com

Keywords：

Prone position ventilation; Interstitial lung disease; Acute respiratory distress syndrome; Hemodynamics

DOI：

10.7507/1671-6205.2016031

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effect of prone position ventilation (PPV) on hemodynamics in patients with interstitial lung disease (ILD) concurrent with acute respiratory distress syndrome (ARDS) or not. Methods Severe ARDS patients received PPV treatment in intensive care unit from 2013 to 2015 were retrospectively analyzed. Pulse index continuous cardiac output (PiCCO) monitoring indices were compared 2h before PPV (PPV-2), in-PPV (PPVmean) and 2h after turn back to supine position (PPV+2), including mean arterial pressure (MAP), cardiac index (CI), intrathoracic blood volume index (ITBVI), etc. Heart function, liver function, renal function, coagulative function were compared before and after all the PPV treatment. Results Thirty-six severe pulmonary ARDS patients were recruited. Norepinephrine (NE) dose was (0.14±0.10) μg·kg^-1·min^-1 and lactate concentration was (1.70±0.57) mmol/L before PPV. CI in all the patients was increased [(4.06±0.95) L·min^-1·m^-2 vs. (3.98±1.05) L·min^-1·m^-2, P > 0.05) and central venous oxygen saturation, ITBVI [(76.94±8.94)% vs. (70.67±8.23)%, (982.17±245.87) mL/m² vs. (912.97±177.65) mL/m², P < 0.05)] were significantly increased compared with PPV-2, while heart rate (HR), MAP, urine volume were decreased (P > 0.05). The patients were divided into an ILD group (n=17) andanon-ILD group (n=19),and no significant differences were found in baseline data between two groups. Compared with PPV-2, MAP was significant decreased at PPV+2 [(85.44±10.84) mm Hg vs. (89.21±10.92) mm Hg, P < 0.05) in the ILD group. Compared with PPVmean, CI was obviously declined at PPV+2 in the ILD group. Activated partial thromboplastin time was increased [(67.04±97.52)s vs. (41.24±8.72) s, P < 0.05] and BUN was higher [(10.64±4.95) μmol/L vs. (8.18±3.88) μmol/L, P < 0.05] in the ILD group, while no significant difference was found in the non-ILD group. Conclusion PPV will not affect cardiac output in severe ARDS patients with ILD. It can increase venous return and improve tissue perfusion, but the perfusion of the abdomen organ need to be monitored cautiously.

Citation： ChenSibei, YuYuheng, LiuDongdong, ZhangJie, YangChun, SangLing, XuYonghao, SunQingwen, NongLingbo, XuYuanda, LiuXiaoqing, LiYimin, HeWeiqun. Effect of Prone Position Ventilation on Hemodynamics in Patients with Interstitial Lung Disease Concurrent with Acute Respiratory Distress Syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(2): 127-132. doi: 10.7507/1671-6205.2016031 Copy

1.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al.Acute respiratory distress syndrome: the Berlin Definition.JAMA, 2012, 307: 2526-2533.
2.	Diaz JV, Brower R, Calfee CS, et al.Therapeutic strategies for severe acute lung injury.Crit Care Med, 2010, 38: 1644-1650.
3.	Gattinoni L, Taccone P, Carlesso E, et al.Prone position in acute respiratory distress syndrome.Rationale, indications, and limits.Am J Respir Crit Care Med, 2013, 188: 1286-1293.
4.	Ball C, Adams J, Boyce S, et al.Clinical guidelines for the use of the prone position in acute respiratory distress syndrome.Intensive Crit Care Nurs, 2001, 17: 94-104.
5.	万献尧, 黄伟, 张久之,等.急性呼吸窘迫综合征机械通气患者院内死亡的危险因素分析.中国呼吸与危重监护杂志, 2006, 5: 4-6.
6.	宋鹏, 李琦, 王长征,等.17例重症急性呼吸窘迫综合征临床资料回顾性分析.中国呼吸与危重监护杂志, 2006, 5: 35-38.
7.	Sud S, Friedrich JO, Adhikari NK, et al.Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis.CMAJ, 2014, 186: E381-E390.
8.	Hu SL, He HL, Pan C, et al.The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials.Crit Care, 2014, 18: R109.
9.	韩炳智, 韩韬, 吴志峰.重症吸入性肺炎合并ARDS患者行俯卧位机械通气时氧合、血流动力学及气道引流的研究.中国呼吸与危重监护杂志, 2014, 13: 78-81.
10.	潘亮, 马迎民, 刘又宁,等.采用压力支持方式进行俯卧位通气对急性呼吸窘迫综合征的影响(附一例报告).中国呼吸与危重监护杂志, 2004, 3: 190-191.
11.	Douglas WW, Rehder K, Froukje MB, et al.Improved oxygenation in patients with acute respiratory distress syndrome.Am Rev Respir Dis, 1974, 115: 559-566.
12.	Jozwiak M, Teboul J L, Anguel N, et al.Beneficial hemodynamic effects of prone positioning in patients with acute respiratory distress syndrome.Am J Respir Crit Care Med, 2013, 188: 1428-1433.
13.	Orchard CH, Sanchez de Leon R, Sykes MK.The relationship between hypoxic pulmonary vasoconstriction and arterial oxygen tension in the intact dog.J Physiol, 1983, 338: 61-74.
14.	Vieillard-Baron A, Charron C, Caille V, et al.Prone positioning unloads the right ventricle in severe ARDS.Chest, 2007, 132: 1440-1446.
15.	Kobirumaki-Shimozawa F, Inoue T, Shintani SA, et al.Cardiac thin filament regulation and the Frank-Starling mechanism.J Physiol Sci, 2014, 64: 221-232.
16.	Hering R, Wrigge H, Vorwerk R, et al.The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung injury.Anesth Analg, 2001, 92: 1226-1231.

1. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al.Acute respiratory distress syndrome: the Berlin Definition.JAMA, 2012, 307: 2526-2533.
2. Diaz JV, Brower R, Calfee CS, et al.Therapeutic strategies for severe acute lung injury.Crit Care Med, 2010, 38: 1644-1650.
3. Gattinoni L, Taccone P, Carlesso E, et al.Prone position in acute respiratory distress syndrome.Rationale, indications, and limits.Am J Respir Crit Care Med, 2013, 188: 1286-1293.
4. Ball C, Adams J, Boyce S, et al.Clinical guidelines for the use of the prone position in acute respiratory distress syndrome.Intensive Crit Care Nurs, 2001, 17: 94-104.
5. 万献尧, 黄伟, 张久之,等.急性呼吸窘迫综合征机械通气患者院内死亡的危险因素分析.中国呼吸与危重监护杂志, 2006, 5: 4-6.
6. 宋鹏, 李琦, 王长征,等.17例重症急性呼吸窘迫综合征临床资料回顾性分析.中国呼吸与危重监护杂志, 2006, 5: 35-38.
7. Sud S, Friedrich JO, Adhikari NK, et al.Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis.CMAJ, 2014, 186: E381-E390.
8. Hu SL, He HL, Pan C, et al.The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials.Crit Care, 2014, 18: R109.
9. 韩炳智, 韩韬, 吴志峰.重症吸入性肺炎合并ARDS患者行俯卧位机械通气时氧合、血流动力学及气道引流的研究.中国呼吸与危重监护杂志, 2014, 13: 78-81.
10. 潘亮, 马迎民, 刘又宁,等.采用压力支持方式进行俯卧位通气对急性呼吸窘迫综合征的影响(附一例报告).中国呼吸与危重监护杂志, 2004, 3: 190-191.
11. Douglas WW, Rehder K, Froukje MB, et al.Improved oxygenation in patients with acute respiratory distress syndrome.Am Rev Respir Dis, 1974, 115: 559-566.
12. Jozwiak M, Teboul J L, Anguel N, et al.Beneficial hemodynamic effects of prone positioning in patients with acute respiratory distress syndrome.Am J Respir Crit Care Med, 2013, 188: 1428-1433.
13. Orchard CH, Sanchez de Leon R, Sykes MK.The relationship between hypoxic pulmonary vasoconstriction and arterial oxygen tension in the intact dog.J Physiol, 1983, 338: 61-74.
14. Vieillard-Baron A, Charron C, Caille V, et al.Prone positioning unloads the right ventricle in severe ARDS.Chest, 2007, 132: 1440-1446.
15. Kobirumaki-Shimozawa F, Inoue T, Shintani SA, et al.Cardiac thin filament regulation and the Frank-Starling mechanism.J Physiol Sci, 2014, 64: 221-232.
16. Hering R, Wrigge H, Vorwerk R, et al.The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung injury.Anesth Analg, 2001, 92: 1226-1231.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of Prone Position Ventilation on Hemodynamics in Patients with Interstitial Lung Disease Concurrent with Acute Respiratory Distress Syndrome

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content