Prone Positioning in Severe Acute Respiratory Distress Syndrome

Guérin, Claude; Reignier, Jean; Richard, Jean-Christophe; Beuret, Pascal; Gacouin, Arnaud; Boulain, Thierry; Mercier, Emmanuelle; Badet, Michel; Mercat, Alain; Baudin, Olivier T.; Clavel, M.; Chatellier, Delphine; Jaber, Samir; Rosselli, Sylvène; Mancebo, Jordi; Sirodot, Michel; Hilbert, Gilles; Bengler, Christian; Richecoeur, Jack; Gainnier, Marc; Bayle, Frédérique; Bourdin, Gaël; Leray, Véronique; Girard, R.; Baboi, Loredana; Ayzac, Louis

doi:10.1056/nejmoa1214103

Cited by 3,215 publications

(2,927 citation statements)

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“…This is a common metric of choice for describing the severity of hypoxemic respiratory failure in the ICU literature and has previously been used in HPS 10, 17. We defined a response to therapy as a change in PF ratio of ≥20%, based on 3 factors: (1) this is an accepted threshold for minimal clinically relevant change 18, 19; (2) smaller percentage changes could result from simple fluctuations in PaO 2 , given baseline PaO 2 's of <65–70 mmHg (corresponding to a saturation of <85%) in patients entering the algorithm 20; and (3) the previously reported top range for mean coefficient of variation for PaO 2 is 10–11% over a 1‐h period in medically stable ICU patients, whereby a 20% change approximates the variation expected by 2 standard deviations (as a proportion of baseline value) 21.…”

Section: Resultsmentioning

confidence: 99%

Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary Syndrome

Nayyar

Man

Granton

et al. 2015

American Journal of Transplantation

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The hepatopulmonary syndrome (HPS) is defined as the triad of liver disease, intrapulmonary vascular dilatation, and abnormal gas exchange, and is found in 10–32% of patients with liver disease. Liver transplantation is the only known cure for HPS, but patients can develop severe posttransplant hypoxemia, defined as a need for 100% inspired oxygen to maintain a saturation of ≥85%. This complication is seen in 6–21% of patients and carries a 45% mortality. Its management requires the application of specific strategies targeting the underlying physiologic abnormalities in HPS, but awareness of these strategies and knowledge on their optimal use is limited. We reviewed existing literature to identify strategies that can be used for this complication, and developed a clinical management algorithm based on best evidence and expert opinion. Evidence was limited to case reports and case series, and we determined which treatments to include in the algorithm and their recommended sequence based on their relative likelihood of success, invasiveness, and risk. Recommended therapies include: Trendelenburg positioning, inhaled epoprostenol or nitric oxide, methylene blue, embolization of abnormal pulmonary vessels, and extracorporeal life support. Availability and use of this pragmatic algorithm may improve management of this complication, and will benefit from prospective validation.

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Section: Resultsmentioning

confidence: 99%

Proposed Management Algorithm for Severe Hypoxemia After Liver Transplantation in the Hepatopulmonary Syndrome

Nayyar

Man

Granton

et al. 2015

American Journal of Transplantation

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“…Weitere Ziele sind die Vermeidung/Minimierung des Lungenschadens und die Sekretmobilisation. Es handelt sich um eine bedeutende Therapiemaßnahme in Ergänzung zu einer optimierten Beatmungsstrategie ( [15,25,47,99]; Evidenzgrad 1a).…”

Section: Rationale Der Bauchlagerungunclassified

Kurzversion S2e-Leitlinie – „Lagerungstherapie und Frühmobilisation zur Prophylaxe oder Therapie von pulmonalen Funktionsstörungen“

Bein

Bischoff²,

Brückner

et al. 2015

Anaesthesist

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“…Caution should be applied in centers that do not have extensive experience with prone positioning. In patients with ARDS and severity criteria (PaO 2 /FIO 2 less than 150 mmHg with PEEP of at least 5 cmH 2 O and FIO 2 of at least 0.6) a significant improvement in survival was demonstrated as compared to the supine position in the PROSEVA trial [14]. This benefit was also observed in the lowest quartile of PaO 2 /FIO 2 at the time of randomization, which ranged from 45 to 87 mmHg.…”

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confidence: 93%