Prone Position Ventilation Research Articles

FISIOTERAPIA RESPIRATÓRTIA NO PACIENTE CRÍTICO DA UNIDADE DE TERAPIA INTENSIVA (UTI).

Critically ill patients admitted to the ICU often require intensive respiratory support. Respiratory physiotherapy plays a crucial role in the treatment of these conditions, using techniques such as kinesiotherapy, bronchial hygiene maneuvers, and oxygen therapy to improve lung function and prevent respiratory complications. These interventions seek to optimize ventilation, perfusion, and secretion clearance, promoting recovery and clinical stability of patients. The study aims to highlight the importance of respiratory physiotherapy in the ICU, analyzing effective techniques for critically ill patients. The research methodology was given through a review of scientific literature in the Google Scholar, Scielo, and BVS databases, covering publications between 2016 and 2024, using the descriptors Respiratory physiotherapy, Critical patient, Intensive care unit (ICU). Early mobilization techniques, prone positioning, and noninvasive ventilation have been shown to be beneficial, contributing to lung aeration, reduced ventilation time, and improvements in oxygenation. Respiratory physiotherapy is essential for critically ill patients, promoting faster and more effective recovery and reducing the length of stay in the ICU, which has a positive impact on public health and respiratory health.

Effect of Prone Position Ventilation in Patients with Severe Craniocerebral Injury Complicated with Pulmonary Infection

Objective: To investigate the effects of prone ventilation in patients with severe traumatic brain injury combined with pulmonary infection. Methods: A total of 100 patients with severe traumatic brain injury combined with pulmonary infection in the hospital were randomly divided into a prone ventilation group and a conventional ventilation group, with 50 patients in each group. The Glasgow Coma Scale (GCS) score, APACHE II score, sputum culture results, oxygenation indicators, and prognosis were compared between the two groups. Data were processed using SPSS 25.0 statistical software, and t-tests and chi-square tests were used to compare continuous and categorical variables, respectively. Results: The experimental group showed better oxygenation indicators, a lower positive rate of sputum cultures, and reduced intracranial pressure compared to the control group (all P < 0.05). Multivariate Cox regression analysis indicated that GCS score, APACHE II score, and prone ventilation were independent risk factors affecting patient prognosis (all P < 0.05). Conclusion: Prone ventilation can improve oxygenation, reduce the risk of pulmonary infection, and decrease intracranial pressure in patients with severe traumatic brain injury combined with pulmonary infection, thereby improving patient prognosis. GCS score and APACHE II score can serve as important indicators for prognostic evaluation.

Awake prone positioning in an infant following living donor liver transplantation

BackgroundProne position has been proven to improve ventilation and oxygenation in infants. Currently, there are few reports of early prone position ventilation after pediatric liver transplantation. Here, we present our experience with prone position in an infant following living donor liver transplantation, in an attempt to improve oxygenation.Case presentationAn 8-month-old boy, 7.5 kg, experienced two failed extubations that presented with Type II respiratory failure due to dyspnea, potentially caused by consolidation and airway secretions. To prevent the third failure of extubation, prone position ventilation was implemented after the third extubation on the 11th postoperative day. Oxygenation increased after each prone position session with no signs of transplant liver ischemia or other adverse outcomes. Following two days of continuous prone position, airway secretions decreased, and the infant was discharged from the ICU. The third extubation procedure was successful.ConclusionsProne position ventilation may be effective in this infant without adverse events, indicating that early prone position is not absolutely contraindicated after pediatric liver transplantation. Therefore, more reasonable prone position strategies should be sought in infants undergoing liver transplantation.

A prediction model for nonresponsive outcomes in critically ill patients with acute respiratory distress syndrome undergoing prone position ventilation: A retrospective cohort study

ObjectiveThis study aimed to develop a reliable and effective nomogram model to identify high-risk populations with non-response to prone position ventilation (PPV) in acute respiratory distress syndrome (ARDS) patients. MethodsThis retrospective cohort study included 175 patients with ARDS undergoing PPV. An improvement of ≥ 20 mmHg in the PaO2/FiO2 after the first PPV was defined as a 'response'. For the construction of the model, all patients were randomly assigned to the train and validation cohort according to 2:1. Multivariate logistic regression was useed to develop the nomogram. The area under the receiver operating characteristic curve (AUC), decision curve and calibration curve were assessed to evaluate the efficiency, clinical utility and calibration of the model. ResultsThe overall rate of non-response to PPV in ARDS patients was approximately 32.6 %. In the training cohort and validation cohort, the rate are 29.9 % and 34.5 % respectively. Murray score ≥ 2.5 (OR: 4.29), procalcitonin (PCT) ≥ 2 ng/mL (OR: 2.52), N-terminal pro-B-type natriuretic peptide (Nt-proBNP) ≥ 2000 pg/ml (OR: 2.44), and hemoglobin ≤ 90 g/L (OR: 2.39) were independently associated with the rate of non-response to PPV and combined in prediction model. The model demonstrated good predictive value with AUC of 0.817 and 0.828 in the train and validation cohort. Calibration curve showed good calibration and decision curve analysis indicated favorable clinical utility. ConclusionsThis study constructed a risk prediction model for non-response to PPV, which demonstrated good predictive value and clinical utility. Implications for clinical practiceEarly identification of prone position response in ARDS is essential for timely alternative treatments, improving patient prognosis and healthcare efficiency. The predictive model included representative indicators of patients with ARDS, encompassing parameters such as the acute lung injury (Murray score), cardiac function (Nt-proBNP), infectious status (PCT), and hemoglobin levels.

Anaesthetic management in neonate with rare finding of absent ribs as a part of Jacho Levin syndrome posted for thoracolumbar meningomyelocele repair: A case report

The congenital absence of ribs is a very rare finding. It can manifest as a standalone anomaly or as part of the syndrome. We came across a case in which the absence of ribs was associated with a neural tube defect. These findings were in favor of Jarcho Levin syndrome. Jarcho Levin syndrome, also known as spondylocostal dysostosis, is an uncommon genetic disorder with a global incidence of 1/40000 births. Very few case reports of it are in the Indian literature. It is characterized by vertebral malformations and the congenital absence of ribs, resulting in a crab-like appearance in the chest. It is linked to a wide range of non-skeletal abnormalities, including hydrocephalus, neural tube defects, tracheal anomalies, and abnormalities in the cardiac, renal, gastrointestinal, and urinary systems. The preoperative evaluation should be thoroughly done with a detailed systemic examination for the multisystem affliction of this syndrome. The anesthetic challenges in neonates with Jarcho Levin syndrome includes challenging airways due to defects in skeletal growth and hydrocephalus, proper positioning to avoid sac rupture, prone position ventilation, temperature control and fluid management. The prone position ventilation can be complicated by the absence of ribs and decreased respiratory reserve due to associated scoliosis and kyphosis. This case report highlights the anesthetic management of a three-day-old neonate with Jarcho Levin syndrome posted for thoracolumbar meningomyelocele repair.

A prediction model for secondary invasive fungal infection among severe SARS-CoV-2 positive patients in ICU.

The global COVID-19 pandemic has resulted in over seven million deaths, and IFI can further complicate the clinical course of COVID-19. Coinfection of COVID-19 and IFI (secondary IFI) pose significant threats not only to healthcare systems but also to patient lives. After the control measures for COVID-19 were lifted in China, we observed a substantial number of ICU patients developing COVID-19-associated IFI. This creates an urgent need for predictive assessment of COVID-19 patients in the ICU environment for early detection of suspected fungal infection cases. This study is a single-center, retrospective research endeavor. We conducted a case-control study on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients. The cases consisted of patients who developed any secondary IFI during their ICU stay at Jilin University China-Japan Union Hospital in Changchun, Jilin Province, China, from December 1st, 2022, to August 31st, 2023. The control group consisted of SARS-CoV-2 positive patients without secondary IFI. Descriptive and comparative analyses were performed, and a logistic regression prediction model for secondary IFI in COVID-19 patients was established. Additionally, we observed an increased incidence of COVID-19-associated pulmonary aspergillosis (CAPA) during this pandemic. Therefore, we conducted a univariate subgroup analysis on top of IFI, using non-CAPA patients as the control subgroup. From multivariate analysis, the prediction model identified 6 factors that are significantly associated with IFI, including the use of broad-spectrum antibiotics for more than 2 weeks (aOR=4.14, 95% CI 2.03-8.67), fever (aOR=2.3, 95%CI 1.16-4.55), elevated log IL-6 levels (aOR=1.22, 95% CI 1.04-1.43) and prone position ventilation (aOR=2.38, 95%CI 1.15-4.97) as independent risk factors for COVID-19 secondary IFI. High BMI (BMI ≥ 28 kg/m2) (aOR=0.85, 95% CI 0.75-0.94) and the use of COVID-19 immunoglobulin (aOR=0.45, 95% CI 0.2-0.97) were identified as independent protective factors against COVID-19 secondary IFI. The Receiver Operating Curve (ROC) area under the curve (AUC) of this model was 0.81, indicating good classification. We recommend paying special attention for the occurrence of secondary IFI in COVID-19 patients with low BMI (BMI < 28 kg/m2), elevated log IL-6 levels and fever. Additionally, during the treatment of COVID-19 patients, we emphasize the importance of minimizing the duration of broad-spectrum antibiotic use and highlight the potential of immunoglobulin application in reducing the incidence of IFI.

The use of prone position ventilation in Danish patients with COVID-19-induced severe acute respiratory distress syndrome treated with veno-venous extracorporeal membrane oxygenation: A nationwide cohort study with focus on pulmonary effects.

Prone position ventilation (PPV) is recommended for patients with COVID-19 induced severe Adult Respiratory Distress Syndrome (ARDS) and is used for patients supported with V-V ECMO as well. The purpose of this study was to describe the use of PPV in these patients focusing on physiological effects with the hypothesis that PPV could reduce oxygen need and improve dynamic compliance. This study was a nationwide retrospective analysis of all COVID-19 patients in Denmark from March 2020 - December 2021 with severe ARDS and need of V-V ECMO support. Data on the number of patients treated with PPV, number of PPV sessions, timing, the time spent in prone position, pulmonary physiological response types with analysis of variables affecting the response are reported. Out of 68 patients 44 were treated with 220 PPV sessions and a positive clinical response was observed in 80% of patients but only in 45% of sessions. On a single session level, increased compliance was observed in 38% and increased oxygenation in only 15% of 220 sessions, with within-patient heterogeneity. Higher dynamic compliance at the beginning of a PPV session was associated with a lower delta change in dynamic compliance during PPV. The response to a PPV session could not be predicted by the response in the prior session. Dynamic compliance did not change during the ECMO course. Eighty percent of patients responded positively during a PPV session, but this was not associated with overall pulmonary improvement. On a single patient level, responses were heterogenous and only 45% of sessions resulted in clinical improvement. Response in dynamic compliance was associated with starting values of compliance.

Comparison of venovenous extracorporeal membrane oxygenation, prone position and supine mechanical ventilation for severely hypoxemic acute respiratory distress syndrome: a network meta-analysis.

Severe acute respiratory distress syndrome (ARDS) with PaO2/FiO2 < 80mmHg is a life-threatening condition. The optimal management strategy is unclear. The aim of this meta-analysis was to compare the effects of low tidal volumes (Vt), moderate Vt, prone ventilation, and venovenous extracorporeal membrane oxygenation (VV-ECMO) on mortality in severe ARDS. We performed a frequentist network meta-analysis of randomised controlled trials (RCTs) with participants who had severe ARDS and met eligibility criteria for VV-ECMO or had PaO2/FiO2 < 80mmHg. We applied the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to discern the relative effect of interventions on mortality and the certainty of the evidence. Ten RCTs including 812 participants with severe ARDS were eligible. VV-ECMO reduces mortality compared to low Vt (risk ratio [RR] 0.77, 95% confidence interval [CI] 0.59-0.99, moderate certainty) and compared to moderate Vt (RR 0.75, 95% CI 0.57-0.98, low certainty). Prone ventilation reduces mortality compared to moderate Vt (RR 0.78, 95% CI 0.66-0.93, high certainty) and compared to low Vt (RR 0.81, 95% CI 0.63-1.02, moderate certainty). We found no difference in the network comparison of VV-ECMO compared to prone ventilation (RR 0.95, 95% CI 0.72-1.26), but inferences were based solely on indirect comparisons with very low certainty due to very wide confidence intervals. In adults with ARDS and severe hypoxia, both VV-ECMO (low to moderate certainty evidence) and prone ventilation (moderate to high certainty evidence) improve mortality relative to low and moderate Vt strategies. The impact of VV-ECMO versus prone ventilation remains uncertain.

Establishing a course to train ICU nurses on prone position mechanical ventilation: A Delphi study.

To develop a comprehensive training course for training ICU nurses in prone positioning. A mixed study combining semi-structured interviews and two rounds of Delphi surveys. We constructed a questionnaire after collecting data through a literature review and semi-structured interviews. We used the Delphi expert correspondence method to conduct two rounds of research among 17 experts in the field of critical illness. Data collection took place between May and August 2022. The effective questionnaire recovery rate was 88.2%. The expert authority coefficient was 0.876; the Kendall coordination coefficient was 0.402; the average importance score for each index ranged from 4.00 to 4.93; and the coefficient of variation for each index ranged from 0.05 to 0.19. We established 13 second-level indicators and 41 third-level indicators on prone position ventilation training according to three aspects: training contents, training methods and training assessment. The training system of prone mechanical ventilation for ICU nurses established in this study will provide an effective framework for training and evaluating the practical ability of prone mechanical ventilation for ICU nurses.

Application of prone position ventilation in ventilation strategies for patients with COVID-19.

Patients with coronavirus disease 2019 (COVID-19) have been shown to die mainly due to disease-induced acute respiratory distress syndrome (ARDS). Prone position ventilation (PPV) is an important ventilation strategy in the management of patients with ARDS. To investigate the application of PPV in ventilation strategies for patients with COVID-19. Three hundred patients with COVID-19 admitted to the Intensive Care Unit (ICU) of Shanxi Bethune Hospital from January 2020 to June 2021 were retrospectively collected. Based on body position and conscious state, all patients were divided into three groups: intubation prone position group (n= 110), awake prone position group (n= 90) and supine position group (n= 100); The acute physiology and chronic health evaluation II (APACHE-II) scores, blood gas indicators, complications and other relevant clinical indicators were compared among the three groups. One-way ANOVA was used to compare means between multiple groups for quantitative information that conformed to a normal distribution. Repeated measures ANOVA was used for repeated measures data. Component comparisons were made using the Kruskal-Wallis H rank sum test for non-normally distributed quantitative data. One-way repeated-measures ANOVA main effect analysis showed different effects of different treatments on PaO2 in patients with COVID-19 (F treatment = 256.231, P< 0.05), with the order of awake prone position group > intubation prone position group > supine position group. The effects of the three different treatments on P/F in patients with COVID-19 (F treatment = 311.661, P< 0.05), with the order of awake prone position group > supine position group > intubation prone position group; Moreover, the three treatments had different effects on APACHE II scores in patients with COVID-19 (F treatment = 201.342, P< 0.05), with the order of intubation prone position group > supine position group > awake prone position group. Intubation prone position and awake prone position can improve lung function to some extent in patients with COVID-19, and should be applied as early as possible in patients with COVID-19-induced ARDS.

Prone positioning does not improve outcomes of intubated patients with pneumocystis pneumonia and moderate–severe acute respiratory distress syndrome: a single-center, retrospective, observational, cohort study

BackgroundPneumocystis pneumonia is an uncommon precipitant of acute respiratory distress syndrome and is associated with high mortality. Prone positioning ventilation has been proven to reduce mortality in patients with moderate–severe acute respiratory distress syndrome. We investigated the effect of prone positioning on oxygenation and mortality in intubated patients with pneumocystis pneumonia comorbid with moderate–severe acute respiratory distress syndrome.MethodsIn this single-center, retrospective, observational, cohort study, eligible patients were enrolled at West China Hospital of Sichuan University from January 1, 2017, to December 31, 2021. Data on demographics, clinical features, ventilation parameters, arterial blood gas, and outcomes were collected. Patients were assigned to the prone cohort or supine cohort according to whether they received prone positioning ventilation. The main outcome was 28-day mortality.FindingsA total of 79 patients were included in the study. Sixty-three patients were enrolled in the prone cohort, and 16 patients were enrolled in the supine cohort. The 28-day mortality was 61.9% in the prone cohort and 68.8% in the supine cohort (P = 0.26), and 90-day mortality was 66.7% in the prone cohort and 68.8% in the supine cohort (P = 0.55). Patients in the supine cohort had fewer invasive mechanical ventilation days and more ventilator-free days. The incidence of complications was higher in the prone cohort than in the supine cohort.ConclusionsIn patients with pneumocystis pneumonia and moderate–severe acute respiratory distress syndrome, prone positioning did not decrease 28-day or 90-day mortality.Trial registration ClinicalTrials.gov number, ChiCTR2200063889. Registered on 20 September 2022, https://www.chictr.org.cn/showproj.html?proj=174886.

Effect of prone positioning ventilation on pulmonary function in neonates during venous-arterial extracorporeal membrane oxygenation.

The use of extracorporeal membrane oxygenation (ECMO) technology has significantly decreased mortality rates associated with neonatal pulmonary hypertension and respiratory failure. Prone positioning ventilation (PPV) is a commonly used technique in critically ill infants, designed to improve thoracic pressure gradients, re-expand dorsal lung segments, and increase oxygenation in approximately 70-80% of patients suffering from acute respiratory distress syndrome. This study aimed to evaluate the effects of PPV on pulmonary function in neonates undergoing venous-arterial extracorporeal membrane oxygenation (VA-ECMO). We conducted a retrospective analysis of clinical data from 17 neonates who received ECMO support in our institution, divided into two groups based on ventilation strategy: ECMO with PPV (ECMO-PPV, n=8) and ECMO with supine positioning ventilation (ECMO-SPV, n=9). Parameters such as the P/F ratio [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2)], oxygenation index (OI), respiratory system compliance (Crs), and airway resistance (RAW) were collected and analyzed at baseline, and at 1, 2, and 3 days post-ECMO initiation. In the ECMO-PPV group, these parameters were also assessed 3 days pre-treatment and 2 hours post-treatment initiation. Initial comparisons between ECMO-PPV and ECMO-SPV groups showed no significant difference in PaO2/FiO2, OI, Crs, or RAW. Throughout the ECMO treatment, both groups demonstrated gradual improvements in PaO2/FiO2 and Crs, and reductions in OI and RAW. Notably, by day 3, the ECMO-PPV group exhibited significant improvements in Crs and RAW compared to the ECMO-SPV group (P<0.05). Specifically, in the ECMO-PPV group, Crs significantly increased and RAW decreased after 2 hours of initiating PPV, with these changes becoming statistically significant by day 3 (Crs P=0.03, RAW P=0.03). No severe PPV-related complications were noted. PPV during neonatal ECMO may improve respiratory compliance and reduce RAW, potentially aiding lung recovery. Our findings suggest PPV as a viable strategy for neonates under ECMO support.

Comparison of outcomes and characteristics of patients admitted to the ICU with COVID-19 and other community-acquired pneumonia based on propensity score matching

ObjectiveTo compare the similarities and differences between patients with Coronavirus Disease 2019 (COVID-19) and those with other community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU), utilizing propensity score matching (PSM), regarding hospitalization expenses, treatment options, and prognostic outcomes, aiming to inform the diagnosis and treatment of COVID-19.MethodsPatients admitted to the ICU of the Third People’s Hospital of Datong City, diagnosed with COVID-19 from December 2022 to February 2023, constituted the observation group, while those with other CAP admitted from January to November 2022 formed the control group. Basic information, clinical data at admission, and time from symptom onset to admission were matched using PSM.ResultsA total of 70 patients were included in the COVID-19 group and 119 in the CAP group. The patients were matched by the propensity matching method, and 37 patients were included in each of the last two groups. After matching, COVID-19 had a higher failure rate than CAP, but the difference was not statistically significant (73% vs. 51%, p = 0.055). The utilization rate of antiviral drugs (40% vs. 11%, p = 0.003), γ-globulin (19% vs. 0%, p = 0.011) and prone position ventilation (PPV) (27% vs. 0%, p < 0.001) in patients with COVID-19 were higher than those in the CAP, and the differences were statistically significant. The total hospitalization cost of COVID-19 patients was lower than that of CAP patients, and the difference was statistically significant (27889.5 vs. 50175.9, p = 0.007). The hospital stay for COVID-19 patients was shorter than for CAP patients, but the difference was not statistically significant (10.9 vs. 16.6, p = 0.071).ConclusionOur findings suggest that limited medical resources influenced patient outcomes during the COVID-19 pandemic. Addressing substantial demands for ICU capacity and medications during this period could have potentially reduced the mortality rate among COVID-19 patients.

Efficacy of respiratory rehabilitation in patients with COVID-19: a retrospective study

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of confirmed cases and deaths globally. The purpose of this study was to investigate the therapeutic effect of airway clearance technology combined with prone ventilation on patients infected with COVID-19.Methods38 patients with COVID-19 (severe) who were treated in the intensive rehabilitation group of Shengli Oilfield Central Hospital. They were randomly divided into a control group and an observation group. The control group received prone position ventilation intervention, and the observation group received airway clearance technology combined with prone position ventilation intervention. The changes of oxygen and index, procalcitonin (PCT), interleukin-6 (IL-6) and chest X-ray image indexes were compared between the two groups.ResultThere was no significant difference in age, gender and other general data between the control group and the observation group. The results showed that oxygen index, PCT, IL-6 and chest X-ray image index in the observation group were better than that indexes in the control group.ConclusionAirway clearance technology combined with prone ventilation intervention in patients with COVID-19 can improve the total effective rate and oxygenation index, improve the inflammatory indicators and respiratory function of patients. And it may be widely promoted and used in the treatment of patients with COVID-19 (severe).

Prone position in the mechanical ventilation of acute respiratory distress syndrome children: a systematic review and meta-analysis.

Prone position has been well recognized for the treatment of adult acute respiratory distress syndrome (ARDS). We aimed to evaluate the role of prone position in the mechanical ventilation in children with ARDS, to provide evidence to the treatment and care of children with ARDS. We searched the Pubmed et al. databases by computer until January 23, 2024 for randomized controlled trials (RCTs) on the role of prone position in the mechanical ventilation in children with ARDS. We evaluated the quality of included studies according to the quality evaluation criteria recommended by the Cochrane library. RevMan 5.3 software was used for meta-analysis. 7 RCTs involving 433 children with ARDS were included. Meta-analysis indicated that prone position is beneficial to improve the arterial oxygenation pressure [MD = 4.27 mmHg, 95% CI (3.49, 5.06)], PaO2/FiO2 [MD = 26.97, 95% CI (19.17, 34.77)], reduced the oxygenation index [MD = -3.52, 95% CI (-5.41, -1.64)], mean airway pressure [MD = -1.91 cmH2O, 95% CI (-2.27, -1.55)] and mortality [OR = 0.33, 95% CI (0.15, 0.73), all P < 0.05]. There were no statistical differences in the duration of mechanical ventilation between the prone position group and control group [MD = -17.01, 97.27, 95% CI (-38.28, 4.26), P = 0.12]. Egger test results showed that no significant publication bias was found (all P > 0.05). Prone position ventilation has obvious advantages in improving oxygenation, but there is no significant improvement in the time of mechanical ventilation in the treatment of children with ARDS. In the future, more large-sample, high-quality RCTs are still needed to further analyze the role of prone position in the mechanical ventilation in children with ARDS.

Early Prone Position Ventilation in the Efficacy for Severe Hypoxemia and Neurological Complications Following Acute Type A Aortic Dissection (TAAD) Surgery

Objective To analyze the efficacy of early prone position ventilation in the treatment of severe hypoxemia after surgery for acute type A aortic dissection (TAAD). Methods The patients were divided into a control group and a treatment group. Parameters assessed included blood gas analysis indicators [arterial oxygen partial pressure (PaO2). Results: (1) Blood gas analysis: Before treatment, there was no significant difference in PaO2, SpO2, and OI levels between the two groups; after treatment, the PaO2, SpO2, and OI levels in both groups significantly increased compared to pre-treatment, with a more pronounced improvement in the treatment group than in the control group (p < 0.05). (2) Hemodynamics: Before treatment, there was no significant difference in MAP and HR levels between the two groups; after treatment, the MAP levels increased significantly in both groups compared to pre-treatment, while HR levels decreased significantly, with no significant difference between the groups. (3) Prognosis recovery: MV time, ICU stay, and total hospital stay were significantly lower in the treatment group than in the control group; the 30-day mortality rate was 14.58% in the control group and 12.50% in the treatment group, with no significant difference in 30-day mortality rate between the groups. Conclusion Early prone position ventilation has shown promising application in the treatment of severe hypoxemia after TAAD surgery. Compared to traditional supine position ventilation, the use of early prone position ventilation can further improve blood gas analysis indicators in patients, and shorten MV time, ICU stay, and total hospital stay, thereby accelerating patient recovery.

The effects of prone position ventilation on patients with acute respiratory distress syndrome after cardiac surgery.

This study aimed to investigate the effects of prone position ventilation treatment on patients with acute respiratory distress syndrome (ARDS) after cardiac surgery. Clinical data were collected from 93 hospitalized patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) of cardiology from February 2021 to February 2023. Patients were divided into supine position group (n = 45) and prone position group (n = 48). The difference in 28-days survival rates, blood gas indicators, respiratory mechanics indicators, and adverse events before and after treatment was analyzed. We found that within 28days of admission, 8.33% of ARDS patients in prone position group and 11.11% in supine position group died of all causes (p > .05). After treatment, the levels of arterial PaO2 (103.25 ± 9.44 in prone position group and 91.62 ± 9.18 in supine position group), PaCO2 (30.26 ± 5.54 and 36.56 ± 6.37), blood LAC (1.35 ± 0.37 and 1.68 ± 0.42), oxygenation (232.23 ± 28.56 and 205.13 ± 31.34) and diffusion index (453.48 ± 63.30 and 395.18 ± 58.54) in both groups were improved (p < .001). Moreover, the increase in prone position group was more remarkable. After treatment, the respiratory mechanics indexes of the lung compliance as well as respiratory resistance were improved (p < .05). Moreover, the increase in supine position group was more remarkable (p < .05). The incidence of atelectasis in prone position group was lower than that in supine position group (p < .05). Additionally, the alteration in other adverse events showed no significant difference between the two groups (p > .05). Taken together, prone position ventilation in patients with ARDS after cardiac surgery improved blood gas indexes, hypoxemia, and respiratory mechanics indexes, as well as reduced the incidence of atelectasis.

Successful application of airway pressure release ventilation in a child with severe acute respiratory distress syndrome induced by trauma: a case report

BackgroundTrauma has been identified as one of the risk factors for acute respiratory distress syndrome. Respiratory support can be further complicated by comorbidities of trauma such as primary or secondary lung injury. Conventional ventilation strategies may not be suitable for all trauma-related acute respiratory distress syndrome. Airway pressure release ventilation has emerged as a potential rescue method for patients with acute respiratory distress syndrome and hypoxemia refractory to conventional mechanical ventilation. However, there is a lack of research on the use of airway pressure release ventilation in children with trauma-related acute respiratory distress syndrome. We report a case of airway pressure release ventilation applied to a child with falling injury, severe acute respiratory distress syndrome, hemorrhagic shock, and bilateral hemopneumothorax. We hope this case report presents a potential option for trauma-related acute respiratory distress syndrome and serves as a basis for future research.Case presentationA 15-year-old female with falling injury who developed severe acute respiratory distress syndrome, hemorrhagic shock, and bilateral hemopneumothorax was admitted to the surgical intensive care unit. She presented refractory hypoxemia despite the treatment of conventional ventilation with deep analgesia, sedation, and muscular relaxation. Lung recruitment was ineffective and prone positioning was contraindicated. Her oxygenation significantly improved after the use of airway pressure release ventilation. She was eventually extubated after 12 days of admission and discharged after 42 days of hospitalization.ConclusionAirway pressure release ventilation may be considered early in the management of trauma patients with severe acute respiratory distress syndrome when prone position ventilation cannot be performed and refractory hypoxemia persists despite conventional ventilation and lung recruitment maneuvers.

Changes in Driving Pressure vs Oxygenation as Predictor of Mortality in Moderate to Severe Acute Respiratory Distress Syndrome Patients Receiving Prone Position Ventilation.

Prone position ventilation (PPV) causes improvement in oxygenation, nevertheless, mortality in severe acute respiratory distress syndrome (ARDS) remains high. The changes in the driving pressure (DP) and its role in predicting mortality in moderate to severe ARDS patients receiving PPV is unexplored. A prospective observational study, conducted between September 2020 and February 2023 on moderate-severe ARDS patients requiring PPV. The values of DP and oxygenation (ratio of partial pressure of arterial oxygen to fraction of inspired oxygen [PaO2/FiO2]) before, during, and after PPV were recorded. The aim was to compare the DP and oxygenation before, during and after PPV sessions among moderate- severe ARDS patients, and determine the best predictor of mortality. Total of 52 patients were included; 28-day mortality was 57%. Among the survivors, DP prior to PPV as compared to post-PPV session reduced significantly, from 16.36 ± 2.57 cmH2O to 13.91 ± 1.74 cmH2O (p-value < 0.001), whereas DP did not reduce in the non-survivors (19.43 ± 3.16 to 19.70 ± 3.15 cmH2O (p-value = 0.318)]. Significant improvement in PaO2/FiO2 before PPV to post-PPV among both the survivors [92.75 [67.5-117.75]) to [205.50 (116.25-244.50)], (p-value < 0.001) and also among the non-survivors [87.90 (67.75-100.75)] to [112 (88.00-146.50)], (p-value < 0.001) was noted. Logistic regression analysis showed DP after PPV session as best predictor of mortality (p-value = 0.044) and its AUROC to predict mortality was 0.939, cut-off ≥16 cmH2O, 90% sensitivity, 82% specificity. The Kaplan-Meier curve of DP after PPV ≥16 cmH2O and <16 cmH2O was significant (Log-rank Mantel-Cox p-value < 0.001). Prone position ventilation-induced decrease in DP is prognostic marker of survival than the increase in PaO2/FiO2. There is a primacy of DP, rather than oxygenation, in predicting mortality in moderate-severe ARDS. Post-PPV session DP ≥16 cmH2O was an independent predictor of mortality. Todur P, Nileshwar A, Chaudhuri S, Shanbhag V, Cherisma C. Changes in Driving Pressure vs Oxygenation as Predictor of Mortality in Moderate to Severe Acute Respiratory Distress Syndrome Patients Receiving Prone Position Ventilation. Indian J Crit Care Med 2024;28(2):134-140.

Development of Prone Position Ventilation Device and Study on the Application Effect of Combined Life Support Technology in Critically Ill Patients.

This study aims to evaluate a novel prone position ventilation device designed to enhance patient safety, improve comfort, and reduce adverse events, facilitating prolonged tolerance in critically ill patients. A randomized controlled trial was conducted on 60 critically ill patients from January 2020 to June 2023. Of which, one self-discharged during treatment and another was terminated due to decreased oxygenation, leaving an effective sample of 58 patients. Patients were allocated to either a control group receiving traditional prone positioning aids (ordinary sponge pads and pillows) or an intervention group using a newly developed adjustable prone positioning device. A subset of patients in each group also received life support technologies such as extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). We assessed prone position ventilation tolerance, oxygen saturation increments postintervention, duration of prone positioning, CRRT filter lifespan, and the incidence of adverse events. The intervention group exhibited significantly longer average tolerance to prone positioning (16.6 hours vs. 8.3 hours, P < 0.001 with a difference of 8.3 (4.4, 12.2) hours), higher increases in oxygen saturation postventilation (9% vs. 6%, P < 0.001 with a difference of 3.0 (1.5, 4.5)), and reduced time required for medical staff to position patients (11.7 min vs. 21.8 min, P < 0.001 with a difference of -10.1 (-11.9, -8.3)). Adverse events, including catheter displacement or blockage, facial edema, pressure injuries, and vomiting or aspiration, were markedly lower in the intervention group, with statistical significance (P < 0.05). In patients receiving combined life support, the intervention group demonstrated improved catheter blood drainage and extended CRRT filter longevity. The newly developed adjustable prone ventilation device significantly improves tolerance to prone positioning, enhances oxygenation, and minimizes adverse events in critically ill patients, thereby also facilitating the effective application of life support technologies.