Effect of prone position ventilation on patients with acute respiratory distress syndrome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YUE Weigang , ZHANG Yin , JIANG Youfei , YUAN Peng , YIN Ruiyuan , FENG Xin , ZHU Lei , GUO Hong , YIN Chao , ZHANG Lei , LI Bin ,  ZHANG Zhigang

Department of Intensive Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P. R. China;

Corresponding author：

ZHANG Zhigang, Email: zzg3444@163.com

Keywords：

Acute respiratory distress syndrome; Respiratory failure; Prone position ventilation; Respiratory mechanics

DOI：

10.7507/1671-6205.201807029

Video：

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Objectives To investigate the effect of prone position ventilation (PPV) on patients with acute respiratory distress syndrome (ARDS).Methods Patients with ARDS who received PPV treatment in the this hospital were enrolled from January 1, 2017 to December 31, 2017. The changes in heart rate, respiratory mechanics and blood gas index before and after PPV in patients, the inhaled oxygen concentration (FiO₂), oxygenation index (PaO₂/FiO₂), pressure sore and other related complications were observed and compared in patients before and after PPV.Results A total of 28 patients with ARDS were registered, including 21 males and 7 females. Fourteen patients were complicated with chronic obstructive pulmonary disease (COPD) and 20 were dead in 28 days. After PPV, the peak pressure and plateau pressure decreased significantly, PaO₂ and SaO₂ increased significantly, system compliance improved considerably but PaCO₂ did not change. There was no significant difference in the changes of heart reat, respiratory rate, minute volume, tidal volume and positive end-expiratory pressure between before and after PPV. FiO₂ decreased significantly, PaO₂/FiO₂ increased significantly, and pressure sore increased significantly on day 1 post-PPV in comparison to pre-PPV and on day 7 post-PPV in comparison to day 1 post-PPV. A total of 13 unplanned extubation occurred during the entire PPV procedure, 9 of them were gastric tube slipping, 2 were urethral catheter slipping, 1 was tracheal tube slipping, and 1 was deep venous catheter slipping. There were 17 cases of artificial airway obstruction, 7 cases of hypotension, 3 cases of arrhythmia, and 4 cases of keratitis. In the subgroup analysis, the age of the patients complicated with COPD was significantly higher, but there was no difference in additional baseline data and the survival rate.Conclusion PPV can significantly improve the patient's respiratory status, especially oxygenation and respiratory mechanics, but PPV can increase the incidence of complications such as pressure sore, and PPV does not improve the prognosis.

Citation： YUE Weigang, ZHANG Yin, JIANG Youfei, YUAN Peng, YIN Ruiyuan, FENG Xin, ZHU Lei, GUO Hong, YIN Chao, ZHANG Lei, LI Bin, ZHANG Zhigang. Effect of prone position ventilation on patients with acute respiratory distress syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(6): 532-536. doi: 10.7507/1671-6205.201807029 Copy

1.	Gattinoni L, Tognoni G, Pesenti A, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med, 2001, 345(8): 568-573.
2.	Guerin C, Gaillard S, Lemasson S, et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA, 2004, 292(19): 2379-2387.
3.	陈思蓓, 余裕恒, 刘冬冬, 等. 俯卧位通气对伴间质性肺疾病的急性呼吸窘迫综合征患者血流动力学的影响. 中国呼吸与危重监护杂志, 2016, 15(2): 127-132.
4.	Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
5.	Guerin C, Reignier RJ, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med, 2013, 368(23): 2159-2168.
6.	Lee JM, Bae W, Lee YJ, et al. The efficacy and safety of prone position ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med, 2014, 42(5): 1252-1262.
7.	Mentzelopoulos SD, Roussos C, Zakynthinos SG. et al Prone position in early and severe acute respiratory distress syndrome: a design for a definitive randomized controlled trial. Anesth Analg, 2007, 104(2): 466-468.
8.	Taccone P, Pesenti A, Latini R, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA, 2009, 302(18): 1977-1984.
9.	刘兆润, 董丽, 吴国刚. 俯卧位通气在中重度急性呼吸窘迫综合征的临床应用进展. 中国呼吸与危重监护杂志, 2016, 15(5): 517-519.
10.	Koulouras V, Papathanakos G, Papathanasiou A, et al. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World J Crit Care Med, 2016, 5(2): 121-136.
11.	张华伟, 王耀丽, 张鹏, 等. 俯卧位通气改善重度急性呼吸窘迫综合征氧合的临床分析. 中华肺部疾病杂志(电子版), 2018, 11(1): 177-178.
12.	Cornejo RA, Díaz JC, Tobar EA, et al. Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med, 2013, 188(4): 440-448.
13.	杜转环, 张海丹, 李言鹏, 等. 急性呼吸窘迫综合征患者俯卧位通气获益机制的研究进展. 中国急救医学, 2018, 38(10): 915-920.
14.	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(10): E381-E390.
15.	Wang C, Wang X, Chi C, et al. Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis. Sci Rep, 2016, 6: 22855.
16.	Girard R, Baboi L, Ayzac L, et al. The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med, 2014, 40(3): 397-403.

1. Gattinoni L, Tognoni G, Pesenti A, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med, 2001, 345(8): 568-573.
2. Guerin C, Gaillard S, Lemasson S, et al. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA, 2004, 292(19): 2379-2387.
3. 陈思蓓, 余裕恒, 刘冬冬, 等. 俯卧位通气对伴间质性肺疾病的急性呼吸窘迫综合征患者血流动力学的影响. 中国呼吸与危重监护杂志, 2016, 15(2): 127-132.
4. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
5. Guerin C, Reignier RJ, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med, 2013, 368(23): 2159-2168.
6. Lee JM, Bae W, Lee YJ, et al. The efficacy and safety of prone position ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Crit Care Med, 2014, 42(5): 1252-1262.
7. Mentzelopoulos SD, Roussos C, Zakynthinos SG. et al Prone position in early and severe acute respiratory distress syndrome: a design for a definitive randomized controlled trial. Anesth Analg, 2007, 104(2): 466-468.
8. Taccone P, Pesenti A, Latini R, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA, 2009, 302(18): 1977-1984.
9. 刘兆润, 董丽, 吴国刚. 俯卧位通气在中重度急性呼吸窘迫综合征的临床应用进展. 中国呼吸与危重监护杂志, 2016, 15(5): 517-519.
10. Koulouras V, Papathanakos G, Papathanasiou A, et al. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World J Crit Care Med, 2016, 5(2): 121-136.
11. 张华伟, 王耀丽, 张鹏, 等. 俯卧位通气改善重度急性呼吸窘迫综合征氧合的临床分析. 中华肺部疾病杂志(电子版), 2018, 11(1): 177-178.
12. Cornejo RA, Díaz JC, Tobar EA, et al. Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med, 2013, 188(4): 440-448.
13. 杜转环, 张海丹, 李言鹏, 等. 急性呼吸窘迫综合征患者俯卧位通气获益机制的研究进展. 中国急救医学, 2018, 38(10): 915-920.
14. 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(10): E381-E390.
15. Wang C, Wang X, Chi C, et al. Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis. Sci Rep, 2016, 6: 22855.
16. Girard R, Baboi L, Ayzac L, et al. The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med, 2014, 40(3): 397-403.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of prone position ventilation on patients with acute respiratory distress syndrome

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