SESSION TYPE: Respiratory Support Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: The duration of prone positioning (PP) may be a determinant of its effectiveness in patients with acute respiratory distress syndrome (ARDS). Prone ventilation may reduce mortality in this group of patients when it is applied for more than 24 continuous hours. This study describes the clinical characteristics and outcomes of critically ill patients with ARDS who were ventilated with continuous PP.
METHODS: The present study was observational and descriptive study. Setting: Intensive Care Unit (ICU), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán located in Mexico City. Twenty three patients with primary ARDS who were ventilated with continuous PP (mechanical ventilation for more than 24 continuous hours) from January 2009 to January 2011 were included. We defined PaCO2 responders those patients who decreased their PaCO2≥ 1 mm Hg after 6 hours.Continuous variables are expressed as means ± standard deviation, or as medians and interquartile ranges, if the distribution was skewed. Categorical variables are expressed as percentage. Student’s t-test or the Mann-Whitney U test were used to compare continuous variables and, the Chi-squared or Fisher’s exact test was used to compare categorical variables. A two-sided p value <0.05 was used to determine statistical significance.
RESULTS: All patients had primary ARDS (pneumonia).The mean duration of PP was 5.6 ± 3.8 days and the mean period from diagnosis (ARDS) to PP was 4.8 ± 4 days. The two groups (survivors and non-survivors) had similar PaO2/FIO2 before PP (74.8±29.1 vs 87.6±41.3, p=0.405) and after PP (68.9±14.3 vs 71±13, p=0.711). The PaCO2 decreased ≥ 1 mm Hg after 6 hours of PP in 9 of 23 (39.1%) patients. No statistically significant difference was found between survivors and non-survivors in terms of arterial blood gas exchange variables, acid-base variables or ventilator variables before and after PP. The most frequent complications related to PP were edema facial (95.7%) and pressure sores (60.9%). There were no unplanned tracheal extubations. No significant difference in ICU mortality between responders and non-responders was observed (50% vs 55.5%, p=0.999). The ICU mortality rate was 52.1%.
CONCLUSIONS: The clinical course of patients with primary ARDS and severe hypoxemia requiring continuous ventilation in PP have similar ICU mortality to that reported in other studies with different protocols of ventilation in PP.
CLINICAL IMPLICATIONS: Continuous PP could be used for the ventilatory management of patients with ARDS.
DISCLOSURE: The following authors have nothing to disclose: Silvio Ñamendys-Silva, Carmen Hernández-Cárdenas, Gil Vásquez-Barahona, Marco Silva-Medina, José Baltazar-Torres, Eduardo Rivero-Sigarroa, Guillermo Domínguez-Cherít
No Product/Research Disclosure InformationInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Instituto Nacional de Cancerología, Mexico City, Mexico