Peniche MKG, Sánchez DJS, Castañeda VE, Calyeca SMV, Díaz GSP, Pin GE

Language: Spanish
References: 16
Page: 198-204
PDF size: 208.74 Kb.

ABSTRACT

Background: Acute respiratory distress syndrome (ARDS) due to pulmonary disease is currently a condition that endangers the patient’s life, when severe and refractory hypoxemia develops, therapeutic strategies are limited and even controversial. Mechanical ventilation in prone position conducted early and prolonged is associated with increased survival.
Objetives: To determine the mortality associated with severe ARDS by influenza using a strategy of prolonged mechanical ventilation in prone position.
Materials and Methods: A prospective, cross-sectional, descriptive study intervention. March 2016 patients were recruited to April 2016 with the diagnosis of severe ARDS, which will enter the Intensive Care Unit (ICU). They were grouped patients according to outcome (improvement or death).
Results: Nine patients were included, with a mean age of 47 ± 16 years. 78% were men. The most frequent comorbidity was hypertension with 44%. During their stay, eight patients underwent mechanical ventilation in prone position and were grouped according to the outcome. Three patients died and six were discharged from the ICU for improvement. No significant difference was observed in age, duration, pH levels, PaO₂, PaCO₂, HCO₃ or SOFA at admission in both groups (p › 0.05 in all cases). Ninety six hours after pronation values PEEP were higher in patients who died (p = 0.026) and parameters ABG decrease in O₂ levels and PaO₂/FiO₂ was observed, in addition to increase in FiO2 requirements in the patient who died, were statistically significant (p ‹ 0.05). Other factors that were analyzed were history of hypertension, diabetes mellitus, smoking, time pronation, handling and use of steroid antibiotics prior to admission to the ICU. (Fisher exact test with p › 0.05 and no significant OR in all cases).
Conclusions: Refractory hypoxemia is the most important factor involved with mortality in patients with severe ARDS. Mechanical ventilation in the prone position early and prolonged by 48 hours should be considered a standard practice in this patient group.

REFERENCES

1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967; 12: 319-323.

2. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000;342:1334-1349.

3. Villar J. What is the acute respiratory distress syndrome? Respir Care. 2011;56:1539-1545.

4. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526-2533.

5. Chiumello D, Brioni M. Severe hypoxemia: which strategy to choose. Crit Care 2016; 20:132.

6. Villar J, Kacmarek RM. What is new in refractory hypoxemia? Intensive Care Med. 2013;39:1207-1210.

7. Piehl MA, Brown RS. Use of extreme position changes in acute respiratory failure. Crit Care Med. 1976;4:13-14.

8. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368:2159-2168.

9. Bein T, Grasso S, Moerer O, Quintel M, Guerin C, Deja M, et al. The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hipoxemia. Intensive Care Med. 2016;42:699-711.

10. Fessler HE, Talmor DS. Should prone positioning be routinely used for lung protection during mechanical ventilation? Respir Care. 2010;55:88-99.

11. Guérin C. Prone ventilation in acute respiratory distress syndrome. Eur Respir Rev. 2014;23:249-257.

12. Koulouras V, Papathanakos G, Papathanasiou A, Nakos G. Efficacy of prone position in acute respiratory distress syndrome patients: a pathophysiology-based review. World J Crit Care Med. 2016;5:121-136.

13. Bloomfield R, Noble D, Sudlow A. Prone position for acute respiratory failure in adults. Cochrane Database Syst Rev. 2015;13:CD008095.

14. Villar J, Ambrós A, Soler J, Martínez D, Ferrando C, Solano R, et al. Age, PaO2/FiO2, and Plateau Pressure Score: a proposal for a simple outcome score in patients with the acute respiratory distress syndrome. Crit Care Med. 2016;44:1361-1369.

15. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1330.

16. Kimmoun A, Roche S, Bridey C, Vanhuyse F, Fay R, Girerd N, et al. Prolonged prone positioning under VV-ECMO is safe and improves oxygenation and respiratory compliance. Ann Intensive Care. 2015;5:35.