Extended prone position ventilation in severe acute respiratory distress syndrome: a pilot feasibility study.

摘要

OBJECTIVES: The aim of the study was to evaluate the safety of extended prone position ventilation (PPV) and its impact on respiratory function in patients with severe acute respiratory distress syndrome (ARDS). DESIGN: This was a prospective interventional study. SETTING: Patients were recruited from a mixed medical-surgical intensive care unit in a university hospital. PATIENTS: Fifteen consecutive patients with severe ARDS, previously unresponsive to positive end-expiratory pressure adjustment, were treated with PPV. INTERVENTION: Prone position ventilation for 48 hours or until the oxygenation index was 10 or less (extended PPV). RESULTS: The elapsed time from the initiation of mechanical ventilation to pronation was 35 +/- 11 hours. Prone position ventilation was continuously maintained for 55 +/- 7 hours. Two patients developed grade II pressure ulcers of small extent. None of the patients experienced life-threatening complications or hemodynamic instability during the procedure. The patients showed a statistically significant improvement in Pao(2)/Fio(2) (92 +/- 12 vs 227 +/- 43, P < .0001) and oxygenation index (22 +/- 5 vs 8 +/- 2, P < .0001), reduction of PaCo(2) (54 +/- 9 vs 39 +/- 4, P < .0001) and plateau pressure (32 +/- 2 vs 27 +/- 3, P < .0001), and increment of the static compliance (21 +/- 3 vs 37 +/- 6, P < .0001) with extended PPV. All the parameters continued to improve significantly while they remained in prone position and did not change upon returning the patients to the supine position. CONCLUSIONS: The results obtained suggest that extended PPV is safe and effective in patients with severe ARDS when it is carried out by a trained staff and within an established protocol. Extended PPV is emerging as an effective therapy in the rescue of patients from severe ARDS.