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How to choose the duration of prone-position ventilation between patients with acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease?

Objectives

To determine the different effect of prone-position ventilation (PPV) in patients with acute respiratory distress syndrome (ARDS) resulting from a pulmonary cause (ARDSp) and that from an extrapulmonary cause (ARDSexp) on oxygenation, respiratory mechanics and hemodynamics. To choose the duration of ventilation in the prone position in the two groups.

Methods

Nine ARDSp patients and seven ARDSexp patients within 3 days of onset of ARDS were included in this study, which were classified as two groups. Patients were placed in prone position for 2 hours. The effect of different times (pre-PPV, PPV 0.5 hours, PPV 2 hours) on oxygenation, respiratory mechanics and hemodynamics were observed. Lung computerized tomography (CT) was obtained in both the supine position and 10 min after turning to the prone position.

Results

Compared with pre-PPV, in ARDSp the PaO2/FiO2 was not increased after 0.5 hours, and increased only after 2 hours in the prone position (130.6 ± 36.2 mmHg to 165.1 ± 72.3 mmHg, P < 0.05). But in ARDSexp, PaO2/FiO2 was significantly increased after 0.5 hours and 2 hours in the prone position (116.5 ± 55.0 mmHg to 163.2 ± 46.4 mmHg and 182.7 ± 87.7 mmHg, P < 0.05). After 0.5 hours in the prone position the responding ratio of ARDSexp was higher than ARDSp (100% vs 11.1%, P = 0.0007). After 2 hours, no significant difference of responding ratio was found between the two groups (85.7% vs 66.7%, P = 0.392). The changes of the PO2 were similar to the PaO2/FiO2. The PCO2 and the Cst, rs did not differ significantly between the prone position and the supine position in the two groups. In ARDSp, the Raw was 10.8 ± 1.4 cmH2O/s/l in the supine position, and it was significantly decreased after 2 hours in the prone position (8.4 ± 1.8 cmH2O/s/l) (P < 0.05). Chest CT scans of ARDSp and ARDSexp patients were markedly different.

Conclusions

PPV could be used to improve severe hypoxemia of ARDS. It improved the PaO2/FiO2 ratio rapidly in ARDSexp, but should prolong the period in ARDSp.

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Huang, Y., Qiu, H. & Liu, L. How to choose the duration of prone-position ventilation between patients with acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease?. Crit Care 9, P106 (2005). https://doi.org/10.1186/cc3169

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Keywords

  • Public Health
  • Computerize Tomography
  • Emergency Medicine
  • Respiratory Distress
  • Computerize Tomography Scan