Gas Exchange of prone positioning in influenza pneumonia-related acute respiratory distress syndrome: A multicenter retrospective cohort study in Taiwan

2019 ◽  
Author(s):  
Ko-Wei Chang ◽  
Shih-Wei Lin ◽  
Li-Pang Chuang ◽  
Shinn-Jye Liang ◽  
Kuang-Yao Yang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Distress Syndrome ◽  
Prone Positioning ◽  
Younger Age ◽  
Influenza Pneumonia ◽  
Paco2 Level

Abstract Background: Prone positioning has demonstrated decreased mortality in severe acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the effect of prone positioning in patients with influenza pneumonia-related severe ARDS. Methods: This retrospective study includes eight tertiary referral centers. All the patients with influenza pneumonia induced severe ARDS and receiving prone positioning were enrolled. Demographic data, laboratory data, treatment record, ventilator setting data and outcomes were collected. PaO2 responders were defined as the PaO2/FiO2 ratio increasing by ≥20% or ≥20 mm Hg, while PaCO2 responders were defined as PaCO2 decreasing by ≥1 mm Hg after prone positioning for one day. Results: Sixty-five patients receiving prone positioning were enrolled, with 37 (57%) were PaO2 responders and 33 (51%) were PaCO2 responders. Mortality rates were not significantly different between responders and non-responders. PaCO2 responder survivors had significantly shortened length of stay at the ICU (21.0 ± 13.5 vs. 31.7 ± 18.5 days, P = 0.038) and hospital (30.2 ± 16.6 vs. 43.0 ± 16.3 days, P = 0.013) than did non-responders. Multivariate analysis revealed younger age (odds ratio 0.903, 95% confidence interval 0.824-0.989; P = 0.028) and higher PaCO2 level before prone positioning (odds ratio 1.121 confidence interval 1.020-1.231; P = 0.017) were the predictors of PaCO2 responders. Conclusions: In this multicenter retrospective cohort study of influenza pneumonia patients with severe ARDS receiving prone positioning, PaCO2 responders had modestly better clinical outcomes. Younger age and higher PaCO2 level before prone positioning were the predictors of PaCO2 responders. Keywords: Prone positioning, Acute Respiratory Distress Syndrome, Influenza, Gas exchange, Outcome

An Evidence-Based Protocol for Manual Prone Positioning of Patients With ARDS

2021 ◽  
Vol 41 (6) ◽  
pp. 55-60
Author(s):  
Patrick Ryan ◽  
Cynthia Fine ◽  
Christine DeForge
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prone Positioning ◽  
Hypoxemic Respiratory Failure ◽  
Unplanned Extubations

Background Manual prone positioning has been shown to reduce mortality among patients with moderate to severe acute respiratory distress syndrome, but it is associated with a high incidence of pressure injuries and unplanned extubations. This study investigated the feasibility of safely implementing a manual prone positioning protocol that uses a dedicated device. Review of Evidence A search of CINAHL and Medline identified multiple randomized controlled trials and meta-analyses that demonstrated both the reduction of mortality when prone positioning is used for more than 12 hours per day in patients with acute respiratory distress syndrome and the most common complications of this treatment. Implementation An existing safe patient-handling device was modified to enable staff to safely perform manual prone positioning with few complications for patients receiving mechanical ventilation. All staff received training on the protocol and use of the device before implementation. Evaluation This study included 36 consecutive patients who were admitted to the medical intensive care unit at a large academic medical center because of hypoxemic respiratory failure/acute respiratory distress syndrome and received mechanical ventilation and prone positioning. Data were collected on clinical presentation, interventions, and complications. Sustainability Using the robust protocol and the low-cost device, staff can safely perform a low-volume, high-risk maneuver. This method provides cost savings compared with other prone positioning methods. Conclusions Implementing a prone positioning protocol with a dedicated device is feasible, with fewer complications and lower costs than anticipated.

scholarly journals Early Packed Red Blood Cell Transfusion and Acute Respiratory Distress Syndrome after Trauma

2009 ◽  
Vol 110 (2) ◽  
pp. 351-360 ◽  
Author(s):  
Onuma Chaiwat ◽  
John D. Lang ◽  
Monica S. Vavilala ◽  
Jin Wang ◽  
Ellen J. MacKenzie ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Distress Syndrome ◽  
Red Blood Cell Transfusion ◽  
Thoracic Injury ◽  
National Study ◽  
Trauma Patients

Background Transfusion of packed red blood cells (PRBCs) is a risk factor for acute respiratory distress syndrome (ARDS) in trauma patients. Yet, there is a paucity of information regarding the risk of ARDS with incremental PRBCs exposure. Methods For this retrospective analysis, eligible patients from National Study on Costs and Outcomes of Trauma were included. Our main exposure was defined as units of PRBCs transfused during the first 24 h after admission. The main outcome was ARDS. Results A total of 521 (4.6%) of 14070 patients developed ARDS, and 331 patients (63.5%) who developed ARDS received PRBCs transfusion. Injury severity, thoracic injury, polytrauma, and pneumonia receiving more than 5 units of fresh frozen plasma and 6-10 units of PRBCs were independent predictors of ARDS. Patients receiving more than 5 units of PRBCs had higher risk of developing ARDS (patients who received 6-10 units: adjusted odds ratio 2.5, 95% CI 1.12-5.3; patients who received more than 10 units: odds ratio 2.6, 95% CI 1.1-6.4). Each additional unit of PRBCs transfused conferred a 6% higher risk of ARDS (adjusted odds ratio 1.06; 95% CI 1.03-1.10). Conclusions Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients. Conservative transfusion strategies that decrease PRBC exposure by even 1 unit may be warranted to reduce the risk of ARDS in injured patients.

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