Prone positioning in spontaneously breathing patients with moderate or severe ARDS under invasive mechanical ventilation: a monocentric retrospective study
(2021) Respiratory Care — Vol. 66, n° 5, p. 724-732 (2021)
Files
2020_Wiart_Respir_Care.pdf
Preprint
Open Access - Adobe PDF
- 614.15 KB
Details
- Authors
Castanares Zapatero, Diego 
- Abstract
- OBJECTIVES: Prone positioning (PP) during invasive mechanical ventilation (MV) improves outcomes of patients with severe ARDS. Recent studies suggest that PP in spontaneously breathing non-intubated patients with acute respiratory failure is well tolerated and improves oxygenation. However, little is known regarding assisted ventilation in intubated patients with ARDS undergoing PP. We conducted a retrospective review of our experience proning two clinical series of patients with moderate and severe ARDS (related to COVID-19 in one cohort, unrelated in the other), many of whom were underpressure support ventilation (PSV). METHODS: Retrospective analysis, in one 22-bed mixed ICU. The patients included in the analysis were aged ≥18 years, met the Berlin definition for moderate or severe ARDS (related or not to COVID-19) and underwent prone positioning under invasive mechanical ventilation. RESULTS: Thirty nine patients were included in the analysis. 20 patients had COVID-19 related ARDS while 19 had ARDS related to other etiologies. A total of 113 prone positioning episodes were analyzed, 84 in PSV and 29 in volume assist-control ventilation (VAC). Prone positioning under PSV was well tolerated and was effective in improving arterial oxygenation (increase of the median paO2/FiO2 ratio from 100 [75-120] to 135 [111-161], p<0.0001). No significant difference between VAC and PSV was noted regarding arterial oxygenation during PP. Compared with VAC mode, PP in PSV was associated with a significant decrease in the use of neuromuscular blocking agents (NMBA) (4 vs 69% of patients, p<0.0001), while sedative requirements remained unchanged. CONCLUSIONS: In a retrospective analysis of consecutive patients with moderate or severe ARDS related or not to COVID-19 spontaneous breathing in intubated patients undergoing PP invasive was well tolerated and achieved significant improvement in arterial oxygenation.
- Affiliations
Citations
Wiart, A., Castanares Zapatero, D., Wittebole, X., Maerckx, G., David, G., Laterre, P.-F., & Gérard, L. (2021). Prone positioning in spontaneously breathing patients with moderate or severe ARDS under invasive mechanical ventilation: a monocentric retrospective study. Respiratory Care, 66(5), 724-732. https://doi.org/10.4187/respcare.08461 (Original work published 2021)