Objective To formulate an evidence-based position program for a ventilation patient with acute respiratory distress syndrome (ARDS). Methods Based on fully assessing the patient’s conditions, the clinical problems were put forward according to PICO principles. Such database as The Cochrane Library (2005 to January 2011), DARE (March 2011), CCTR (March 2011), MEDLINE (1996 to January 2011) and CNKI (1979 to January 2011) were retrieved to collect high quality clinical evidence, and then the optimum nursing program was designed in line with patient’s conditions and relatives’ willingness. Results Three meta-analyses, three randomized controlled trials, one systematic review and one anterior-posterior self-control study were included. The available clinical evidence displayed that: a) the prone position adopting earlier, especially for patients with bilateral lungs or left lung functional disorder, was propitious to effectively improve the oxygenation condition and reduce the incidence of ventilator induced lung injury (VILI); b) The long-term prone position could increase the risk of pressure sore; c) The prone position could prolong the survival time, but there was no enough evidence to prove that it could obviously decrease the mortality rate of ARDS. So finally a nursing plan was made in combination with literature evidence and patient’s condition: adopting the prone position after onset within 24 to 36 hours, and enhancing the skin nursing to prevent pressure sore at the same time. After 4-week comprehensive therapy and prone position ventilation, the patient got obvious alleviated in oxygenation, with SpO 2 up to 90% to 100%, stable vital signs, and no more VILI and pressure sore. And then the patient was stopped applying ventilator, and transferred to a general ward for further treatment. Conclusion The earlier adoption of prone position ventilation for severe ARDS can improve oxygenation and reduce ventilator associated pneumonia (VAP) and VILI, but whether it can prolong survival time and reduce mortality for mild ARDS or not still has to be proved with more high quality evidence in the future.
ObjectiveTo investigate the effects of prone position ventilation on oxygenation,hemodynamics and airway drainage in patients with severe aspiration pneumonia with acute respiratory distress syndrome (ARDS). Methods28 patients with severe aspiration pneumonia with ARDS admitted between January 2010 and June 2012 were recruited in the study. They were ventilated in prone position with sedation and paralysis. Mean blood pressure (MAP),heart rate (HR),central venous pressure (CVP),pulse oxygen saturation (SpO2),arterial oxygen tension (PaO2),carbon dioxide partial pressure (PaCO2),oxygenation index (PaO2/FiO2) and sputum drainage were recorded in the time points of initial supine position,prone position 1h,prone position 2h,and return to supine position 2h. ResultsCompared with the time point of initial supine position,PaO2 and PaO2/FiO2 increased significantly after 1 and 2 hours in prone position [PaO2:(85±12)mm Hg and (97±10)mm Hg vs. (65±11)mm Hg;PaO2/FiO2:(150±37)mm Hg and (158±50)mm Hg vs. (130±28)mm Hg;all P<0.05]. The effects of oxygenation improving were persistent 2h after return to supine position [PaO2:(87±11)mm Hg;PaO2/FiO2:(150±52)mm Hg,P<0.05]. There was no significant difference in MAP,HR,CVP,or SpO2 during the study. Airway sputum drainage was significantly increased 2h after in prone position compared with that in initial supine position [(15.3±2.0)mL vs. (8.1±1.1)mL,P<0.05]. Airway sputum drainage had no significant difference among 1h afer prone position,2h after return to supine position and the initial supine position [(9.1±1.0)mL and (8.3±1.2) mL vs. (8.1±1.1)mL,P>0.05]. ConclusionProne position ventilation can improve the oxygenation in patients with severe aspiration pneumonia with ARDS,and the effects of oxygenation improvement can be persistent till 2h after return to supine position. Prone position ventilation can improve sputum drainage without significant influence on hemodynamics,thus can be used as an adjuvant treatment for severe aspiration pneumonia with ARDS. The duration of prone position ventilation needs to be prolonged for patients with much airway secretion.
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.
ObjectiveTo compare the short-and mid-term outcomes of patients with esophageal cancer after subtotal esophagectomy via thoracoscopy in lateral prone position, prone position, or left lateral position. MethodsThis randomized prospectively controlled study was conducted in 121 patients receiving subtotal esophagectomy via thoracoscopy between January 2010 and February 2013. The patients were randomly assigned into three groups to underwent esophagectomy in lateral prone position, prone position, or left lateral position, respectively. Forty-three patients (24 males, 19 females, 61.5±1.5 years) underwent surgery in lateral prone position, 39 patients (21 males, 18 females, 63.2±1.7 years) in prone position and other 39 patients (22 males, 17 females, 60.1±1.6 years) in left lateral position. Esophagogastric anastomosis was performed in the left neck. ResultsThe median operative time in the three groups was 232 (165-296) min, 230 (170-310) min, and 280 (190-380) min, respectively (P < 0.05). The median perioperative bleeding was 262 (185-330) ml, 275 (100-320) ml and 350 (120-560) ml, respectively (P > 0.05). The average number of harvested lymph nodes was 19.1 (9-26), 18.4 (11-23), 10.9 (6-21), respectively (P < 0.05). The postoperative medical complications occurred in 10, 9 and 11 patients in three groups, respectively, with no statistical difference. Twenty patients died in the lateral prone position group after a median follow-up period of 19.2 (6-31) months, 18 patients died in the prone position group after a median follow-up period of 20.7 (8-29) months, and 21 patients died in the left lateral position group after a median follow-up period of 18.5 (12-33) months. ConclusionThe results confirm the feasibility and safety of this minimally invasive esophagectomy via thoracoscopy in lateral prone position, prone position, or left lateral position for patients with esophageal carcinoma. A possible advantage of lateral prone technique is that in case of an emergency, precious time could be saved in changing the position of the patient.
ObjectiveTo evaluate the full thickness idiopathic macular hole (IMH) closure rates in patients positioning non-supine (NSP) compared with patients positioning face-down (FDP). MethodsA computerized search was conducted in the PubMed, Chinese Biomedical Database, China National Knowledge Infrastructure, and VIP database. All the included studies were divided into NSP and FDP group. A total of 9 papers were included in this meta analysis, including 285 eyes (145 eyes with small hole ≤400 μm, 104 eyes with large hole >400 μm) in NSP group and 303 eyes (141 eyes with small hole and 124 eyes with large hole ). RevMan 4.2 software was applied for investigating heterogeneity and meta-analysis, and the risk of publication bias was evaluated. ResultsMeta analysis indicated that there was statistical significance on closure rates betwen NSP and FDP group. The difference of closure rates in small macular hole eyes between NSP and FDP group was statistically significant (OR=0.45, 95%CI 0.13-1.51;P=0.20). The difference of closure rates in large macular hole eyes between NSP and FDP group was statistically significant (OR=0.35, 95%CI 0.17-0.75;P=0.006). ConclusionNSP is equally effective as strict FDP in the repair of small macular hole. Post-operative FDP may improve the macular hole closure rates for holes larger than 400 μm.
ObjectiveTo evaluate the effect of prone position ventilation on mortality in ARDS patients by cumulative meta-analysis.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, VIP, WanFang Data were searched from inception to September 30th, 2016 to collect randomized controlled trials (RCTs) about prone position ventilation in ARDS patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. In accordance with the published literature or published in chronological order, cumulative meta-analysis was performed using Stata12.0 software, and the trial sequencing analysis (TSA) method was used to assess the reliability and authenticity of the results.ResultsA total of 9 RCTs involving 2 359 patients were included. The cumulative meta-analysis results showed that the prone position ventilation could reduce the mortality in ARDS patients (OR=0.60, 95%CI 0.40 to 0.90). The TSA results showed that the definite conclusion had been obtained before the desired amount of information had been reached.ConclusionThe current evidence shows that prone position ventilation is associated with decreased mortality in ARDS patients. Due to limited quality and quantity of included studies, the above results are needed to validate by more studies.
Objective To investigate the early motor development and the risk factors affecting motor development in children with congenital muscular torticollis (CMT) aged 0–3 months. Methods CMT infants admitting to the Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between January 1st, 2016 and April 30th, 2018 were enrolled as CMT group, and contemporaneous age-matched healthy infants were enrolled as the control group. Motor development was assessed with the Alberta Infant Motor scale (AIMS). We collected the birth weight, birth length, mode of birth, sleep position, and prone time when awake as dependent variables, and used multiple linear regression to find the variables that had significant effect on AIMS scores. Results There were 97 CMT infants (62 males and 35 females) with the mean age of (46.8±17.3) days, mean birth weight of (3.34±0.38) kg and mean birth length of (49.56±0.93) cm in the CMT group, while there were 97 healthy infants (60 males and 37 females) with the mean age of (45.1±19.4) days, mean birth weight of (3.38±0.35) kg and mean birth length of (49.84±1.03) cm in the control group, and the differences in sex, age, birth weight, birth length between the two groups were not statistically significant (P>0.05). AIMS centiles showed that 36 infants (37.1%) in CMT group had suspicious or abnormal motor development, while only 12 infants (12.4%) in the control group had; there was a significant statistical difference between the two groups (χ2=15.945, P<0.001). Multiple linear regression analysis showed that the time of prone position when awake and CMT had significant influence on the AIMS scores (F=64.851, P<0.001). Infants who had a long prone position when awake had significantly higher AIMS scores and CMT had a significantly lower AIMS scores (P<0.001). Conclusions The risk of early motor retardation in infants with CMT aged 0–3 months is higher than that in healthy infants of the same age. The decrease in prone position when awake and CMT may be the causes of delayed motor development. Clinical medical personnel and family caregivers should pay more attention to motor development and provide reasonable intervention to CMT infants.
ObjectivesTo investigate the effect of prone position ventilation (PPV) on patients with acute respiratory distress syndrome (ARDS).MethodsPatients 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.ResultsA 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.ConclusionPPV 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.
ObjectiveTo evaluate the surgical outcomes of 25G+ vitrectomy with air tamponade and 1-day prone positioning for idiopathic macular hole (IMH).MethodsA prospective analysis was performed on 39 patients (39 eyes) underwent 25G+ pars plana vitrectomy (PPV) combined with the internal limiting membrane (ILM) removal and fluid-air exchange for IMH from July 2012 to December 2013. After vitrectomy, patients were instructed to keep prone positioning for only 1 day (the air group). These patients were compared to 30 consecutive patients from July 2010 to July 2012, who were conducted 25G+ PPV with 25% SF6 tamponade. They remained in the same face-down position for 3 days postoperatively (SF6 group). Age, gender, logMAR BCVA, macular thickness, macular hole diameter, axial length, macular hole stages and pseudophakic status were collected as baseline characteristics in both groups. The initial hole-closure rate, visual outcome and intra-operative & post-operative complications were evaluated for 6 months. Group comparisons of numeric variables were made by using two sample t -test. Group difference of categorical variables was determined by using standard chi-square test or rank sum test.ResultsThirty nine patients (39 eyes) and 30 patients (30 eyes) were respectively enrolled in air group and SF6 group. The distribution of age (t=－1.63), gender (χ2=0.03), logMAR BCVA (t=0.39), macular thickness (t=－0.93), macular hole diameter (t=－0.70), axial length (t=－0.56), macular hole stages (Z=－0.47) and pseudophakic status (χ2=0.13) was similar in both groups. Anatomical closure of macular holes was achieved in 35 (89.7%) of the 39 eyes in the air group and in 27 eyes (90.0%) in the SF6 group. There was no significant difference of closure rate between the two groups (χ2=0.001, P=0.970). The postoperative visual acuity of gaining, stability and decreasing 2 or more 2 lines was achieved in 23 eyes,10 eyes and 6 eyes in air group and 18 eyes, 6 eyes and 6 eyes in SF6 group. The proportion of visual acuity improvement in air group was lower than that in SF6 group without the statistical significance (Z=－0.08, P=0.93). The gas bubble was absorbed sooner in the air group (mean 8.54±1.74 days) than in the SF6 group (mean 31.10±3.20 days). No retinal break, retinal detachment or endophthalmitis occurred in either group. Postoperatively intraocular pressure was elevated temporarily in 2 eyes of the air group and 3 eyes in the SF6 group. All returned to normal limit after local medication.ConclusionCompared to SF6 group, air group has similar anatomical macular hole closure rate and visual acuity rehabilitation.
ObjectiveTo investigate the factors affecting enteral nutrition tolerance in patients accepting prone position ventilation.MethodsA retrospective study was conducted to analyze the tolerance of enteral nutrition in patients with prone position ventilation from January 2013 to December 2018. The single factor and multiple factors were used to analyze the influencing factors of enteral nutrition tolerance in patients accepting prone position ventilation.ResultsNinety-two patients who met the inclusion criteria were divided into 2 groups according to enteral nutrition tolerance table: 45 patients with good tolerance and 47 patients with poor tolerance. Univariate analysis showed age, use of muscle relaxants, albumin, prealbumin, feeding amount per unit time, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), nutrition risk in critically ill (NUTRIC) score and gastric residual volume were factors affecting the patient's tolerance (P<0.05). Logistic analysis showed that the factors affecting the patient's tolerance during the prone position were age, use of muscle relaxant, albumin, prealbumin, APACHEⅡ, SOFA, and NUTRIC scores (P<0.05).ConclusionFactors affecting enteral nutrition tolerance in patients accepting prone position ventilation are age, use of muscle relaxants, albumin, prealbumin, APACHEⅡ, SOFA and NUTRIC scores.