Oxygenation improves during the first 8 h of extended-duration prone positioning in patients with respiratory failure: a retrospective study

Miyamoto, Kyohei; Kawazoe, Yu; Yasuda, Masato; Shibata, Naoaki; Nakashima, Tsuyoshi; Kida, Maki; Kato, Seiya

doi:10.1186/s40560-014-0052-5

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…We chose different V T between tested PEEP levels to limit lung overdistension and barotrauma during high PEEP while also avoiding lethal hypoxemia during low PEEP. Finally, ventilator settings and body positions were applied in-scanner for relatively short intervals: longer wait times (hours) would likely have enhanced the gas exchange effects of prone positioning (43, 44) but would have been impractical. However, serial CT scans confirmed that inflation distribution was not substantially altered while waiting for up to 1 hour in the prone position ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Diminishing Efficacy of Prone Positioning With Late Application in Evolving Lung Injury

Xin

Martin

Morais

et al. 2021

Critical Care Medicine

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OBJECTIVES: It is not known how lung injury progression during mechanical ventilation modifies pulmonary responses to prone positioning. We compared the effects of prone positioning on regional lung aeration in late versus early stages of lung injury. DESIGN: Prospective, longitudinal imaging study. SETTING: Research imaging facility at The University of Pennsylvania (Philadelphia, PA) and Medical and Surgical ICUs at Massachusetts General Hospital (Boston, MA). SUBJECTS: Anesthetized swine and patients with acute respiratory distress syndrome (acute respiratory distress syndrome). INTERVENTIONS: Lung injury was induced by bronchial hydrochloric acid (3.5 mL/kg) in 10 ventilated Yorkshire pigs and worsened by supine nonprotective ventilation for 24 hours. Whole-lung CT was performed 2 hours after hydrochloric acid (Day 1) in both prone and supine positions and repeated at 24 hours (Day 2). Prone and supine images were registered (superimposed) in pairs to measure the effects of positioning on the aeration of each tissue unit. Two patients with early acute respiratory distress syndrome were compared with two patients with late acute respiratory distress syndrome, using electrical impedance tomography to measure the effects of body position on regional lung mechanics. MEASUREMENTS AND MAIN RESULTS: Gas exchange and respiratory mechanics worsened over 24 hours, indicating lung injury progression. On Day 1, prone positioning reinflated 18.9% ± 5.2% of lung mass in the posterior lung regions. On Day 2, position-associated dorsal reinflation was reduced to 7.3% ± 1.5% (p < 0.05 vs Day 1). Prone positioning decreased aeration in the anterior lungs on both days. Although prone positioning improved posterior lung compliance in the early acute respiratory distress syndrome patients, it had no effect in late acute respiratory distress syndrome subjects. CONCLUSIONS: The effects of prone positioning on lung aeration may depend on the stage of lung injury and duration of prior ventilation; this may limit the clinical efficacy of this treatment if applied late.

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Section: Discussionmentioning

confidence: 99%

Diminishing Efficacy of Prone Positioning With Late Application in Evolving Lung Injury

Xin

Martin

Morais

et al. 2021

Critical Care Medicine

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“…According to our previous experience, we have applied prone ventilation for a longer duration than that stated in the abovementioned guideline, with a maximum duration of 43 h, which temporally cured his hypoxemia. 4,5 This allowed us to implement low tidal volume ventilation, bypassing the need for more invasive and resource-intensive procedures, such as extracorporeal membrane oxygenation (ECMO). Although prone ventilation is recommended for severe ARDS, published reports on the outcomes of prone ventilation used in COVID-19 patients are limited.…”

Section: Discussionmentioning

confidence: 99%

“…Here we reported a 79‐year‐old man with severe ARDS due to SARS‐CoV‐2 infection. According to our previous experience, we have applied prone ventilation for a longer duration than that stated in the abovementioned guideline, with a maximum duration of 43 h, which temporally cured his hypoxemia 4,5 . This allowed us to implement low tidal volume ventilation, bypassing the need for more invasive and resource‐intensive procedures, such as extracorporeal membrane oxygenation (ECMO).…”

Section: Discussionmentioning

confidence: 99%

Protracted course of coronavirus disease with severe acute respiratory distress syndrome: a case report

Kyo¹,

Yonemitsu²,

Tanaka³

et al. 2020

Acute Medicine & Surgery

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Background: Coronavirus disease (COVID-19) is a growing concern worldwide. Approximately 5% of COVID-19 cases require intensive care. However, the optimal treatment for respiratory failure in COVID-19 patients is yet to be determined. Case presentation: A 79-year-old man with severe acute respiratory distress syndrome due to COVID-19 was admitted to our intensive care unit. Prone ventilation was effective in treating the patient's hypoxemia. Furthermore, the patient received lung protective ventilation with a tidal volume of 6-8 mg/kg (predicted body weight). However, the patient's respiratory failure did not improve and he died 16 days after admission because of multiple organ failure. Serial chest computed tomography revealed a change from ground-glass opacity to consolidation pattern in both lungs. Conclusions: We report a protracted case of COVID-19 in a critically ill patient in Japan. Although prone ventilation could contribute to treating hypoxemia, its efficacy in preventing mortality from COVID-19 is unknown.

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“…found a similar result (cumulative incidence of 30%) with proning sessions of a median of 40 h. In this latter study, it should be noted that more than 10% of the sessions had a duration greater than 75 h [ 8 ]. Two observational retrospective studies have shown that the cumulative incidence of grade ≥ III PI associated with extended PP remained extremely low (between 0 and 2.5%) [ 8 , 30 ]. Finally, the occurrence of PI seems to be associated with the cumulated duration of PP and not with the duration of single sessions [ 8 , 31 ].…”

Section: Main Textmentioning

confidence: 99%

Extended prone positioning for intubated ARDS: a review

Walter

Ricard

2023

Crit Care

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During the COVID-19 pandemic, several centers had independently reported extending prone positioning beyond 24 h. Most of these centers reported maintaining patients in prone position until significant clinical improvement was achieved. One center reported extending prone positioning for organizational reasons relying on a predetermined fixed duration. A recent study argued that a clinically driven extension of prone positioning beyond 24 h could be associated with reduced mortality. On a patient level, the main benefit of extending prone positioning beyond 24 h is to maintain a more homogenous distribution of the gas–tissue ratio, thus delaying the increase in overdistention observed when patients are returned to the supine position. On an organizational level, extending prone positioning reduces the workload for both doctors and nurses, which might significantly enhance the quality of care in an epidemic. It might also reduce the incidence of accidental catheter and tracheal tube removal, thereby convincing intensive care units with low incidence of ARDS to prone patients more systematically. The main risk associated with extended prone positioning is an increased incidence of pressure injuries. Up until now, retrospective studies are reassuring, but prospective evaluation is needed. Graphical Abstract

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Oxygenation improves during the first 8 h of extended-duration prone positioning in patients with respiratory failure: a retrospective study

Cited by 7 publications

References 13 publications

Diminishing Efficacy of Prone Positioning With Late Application in Evolving Lung Injury

Diminishing Efficacy of Prone Positioning With Late Application in Evolving Lung Injury

Protracted course of coronavirus disease with severe acute respiratory distress syndrome: a case report

Extended prone positioning for intubated ARDS: a review

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