Prone positioning in severe ARDS requiring extracorporeal membrane oxygenation

Rilinger, Jonathan; Zotzmann, Viviane; Bemtgen, Xavier; Schumacher, Carin; Biever, Paul; Duerschmied, Daniel; Kaier, Klaus; Stachon, Peter; Mühlen, Constantin von zur; Zehender, Manfred; Bode, Christoph; Staudacher, Dawid L.; Wengenmayer, Tobias

doi:10.1186/s13054-020-03110-2

Cited by 52 publications

(87 citation statements)

References 23 publications

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“…Our results suggested that the improvement of PaO 2 lasted for at least 4 hours after the patients were turned back to the supine position, especially for those patients who received PPV for over 16 hours per day. Similar to the results from Guerin et al [16] and Rilinger et al [20], PPV still showed its e ciency on the improvement of the pathophysiological changes of the respiratory system. Both these two studies suggested that the patients should receive PPV for over 16 hours per day and the latest study form Rilinger et al showed that patients would bene t from early PPV when ECMO initiating.…”

Section: Discussionsupporting

confidence: 85%

Prone Position Ventilation for Pediatric Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation: A Propensity Score-Matched Retrospective Multicenter Cohort Study

Zhao

Yang

et al. 2020

SSRN Journal

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Background: Extracorporeal membrane oxygen (ECMO) has used for rescuing severe pediatric acute respiratory distress syndrome (PARDS) for half a century. Prone position ventilation (PPV) has been suggested according to the surviving sepsis campaign (SSC) guideline in children in 2020. We aimed to compare the outcomes and effect of PARDS patients with ECMO+PPV and ECMO only. Design: Retrospective Multicenter pair-matched Study Setting: In the present study, propensity score matching was conducted and the outcomes of severe PARDS patients were analyzed. The effect of PPV was compared as well. The e ciency of PPV included PaO 2 , Oxygen Index (OI), PaO 2 /FiO 2 , compliance of respiratory system and resistance of airway. The primary outcome was hospital mortality. Secondary outcomes included ECMO running time, PICU time, hospital days and mechanical ventilation time of survivors. Patients: 137 PARDS patients with criteria of ECMO from 11 hospitals in 5 years. Interventions: No interventions. Measurements and Main Results: Among 137 patients, 93 patients received ECMO+PPV at the same time and 44 patients didn't. After matching, we got 34 pairs. For the survivors receiving ECMO+PPV, the PaO 2 ,

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Section: Discussionsupporting

confidence: 85%

Prone Position Ventilation for Pediatric Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation: A Propensity Score-Matched Retrospective Multicenter Cohort Study

Zhao

Yang

et al. 2020

SSRN Journal

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“…Second, some centers currently perform prone positioning during ECMO with a goal of reducing VILI [ 41 , 62 ]. Two recent retrospective series of severe ARDS patients showed that prone positioning, while on-ECMO demonstrated higher ECMO-weaning and survival rates [ 62 , 63 ]. However, randomized controlled trials of prone positioning during ECMO are needed before recommending this practice routinely.…”

Section: Specific Management During Vv-ecmomentioning

confidence: 99%

Extracorporeal life support for adults with acute respiratory distress syndrome

et al. 2020

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Extracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to a central vein. Two related forms of ECLS are used. Venovenous extracorporeal membrane oxygenation (ECMO), which uses high blood flow rates to both oxygenate the blood and remove carbon dioxide, may be considered in patients with severe ARDS whose oxygenation or ventilation cannot be maintained adequately with best practice conventional mechanical ventilation and adjunctive therapies, including prone positioning. Extracorporeal carbon dioxide removal (ECCO 2 R) uses lower blood flow rates through smaller cannulae and provides substantial CO 2 elimination (~ 20–70% of total CO 2 production), albeit with marginal improvement in oxygenation. The rationale for using ECCO 2 R in ARDS is to facilitate lung-protective ventilation by allowing a reduction of tidal volume, respiratory rate, plateau pressure, driving pressure and mechanical power delivered by the mechanical ventilator. This narrative review summarizes physiological concepts related to ECLS, as well as the rationale and evidence supporting ECMO and ECCO 2 R for the treatment of ARDS. It also reviews complications, limitations, and the ethical dilemmas that can arise in treating patients with ECLS. Finally, it discusses future key research questions and challenges for this technology.

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“…The prevalence of acute respiratory distress syndrome (ARDS) in patients admitted to the intensive care units (ICU) is approximately 10%, [1] and the mortality rate ranges from 30% to 50% because of the high heterogeneity in ARDS. [2,3] Although pharmaceutical treatment is limited, prone positioning (PP) improves the outcomes of patients with ARDS. [3][4][5] In 1976, Piehl and Brown proposed that PP therapy could improve oxygenation in patients with ARDS.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors to Predict ICU Mortality in Patients with ARDS Who Received Early and Prolonged Prone Positioning Therapy

Lee

2021

Preprint

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Background: Early and prolonged prone positioning (PP) could reduce the mortality in patients with moderate to severe ARDS, however, factors associated with mortality in the intensive care unit (ICU) remain unclear. The aim of this study is to identified factors associated with mortality and create the prognostic score in patients with ARDS who underwent early and prolonged PP. Methods: This retrospective study included patients with moderate to severe ARDS admitted to the intensive care unit (ICU) from January 2015 to June 2018 in a tertiary referral center in Taiwan and who received early and prolonged PP. Demographic data, disease severity score, comorbidities, and clinical outcomes were recorded. Univariate and multivariate regression models were used to estimate the odds ratio (OR) of ICU mortality. Receiver operating characteristic (ROC) curve analysis were performed to identify the cutoff value of parameters. Results: A total of 116 patients were enrolled. In the multivariate analysis, three factors were significantly associated with mortality: renal replacement therapy (RRT; OR: 3.38, 1.55–7.36), malignant comorbidity (OR: 7.42, 2.06–26.70), and noninfluenza-related ARDS (OR: 3.78, 1.07–13.29). Age, RRT, noninfluenza-related ARDS, malignant comorbidity, and APACHE II score were included in a composite prone score, which demonstrated an area under the curve of 0.816 for predicting mortality risk. The mortality risk in ICU was 27.1% in the low-risk group (prone score: 0–2) and 84.2% in the high-risk group (prone score: 3–5). Conclusions: For patients with moderate to severe ARDS even receiving early and prolonged PP in ICU, poor prognostic factors were age, RRT, malignant comorbidity, noninfluenza-related ARDS, and higher APACHE II score. High mortality should be informed to the family of patient if their prone score was more than 3 points.

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Prone positioning in severe ARDS requiring extracorporeal membrane oxygenation

Cited by 52 publications

References 23 publications

Prone Position Ventilation for Pediatric Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation: A Propensity Score-Matched Retrospective Multicenter Cohort Study

Prone Position Ventilation for Pediatric Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation: A Propensity Score-Matched Retrospective Multicenter Cohort Study

Extracorporeal life support for adults with acute respiratory distress syndrome

Prognostic Factors to Predict ICU Mortality in Patients with ARDS Who Received Early and Prolonged Prone Positioning Therapy

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