Effect of prone positioning on gas exchange according to lung morphology in patients with acute respiratory distress syndrome
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: There are limited data on the clinical effects of prone positioning according to lung morphology. We aimed to determine whether the gas exchange response to prone positioning differs according to lung morphology.Methods: This retrospective study included adult patients with moderate-to-severe acute respiratory distress syndrome (ARDS). The lung morphology of ARDS was assessed by chest computed tomography scan and classified as “diffuse” or “focal.” The primary outcome was change in partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio after the first prone positioning session: first, using the entire cohort, and second, using subgroups of patients with diffuse ARDS matched 2 to 1 with patients with focal ARDS at baseline.Results: Ninety-five patients were included (focal ARDS group, 23; diffuse ARDS group, 72). Before prone positioning, the focal ARDS group showed worse oxygenation than the diffuse ARDS group (median PaO2/FiO2 ratio, 79.9 mm Hg [interquartile range (IQR)], 67.7–112.6 vs. 104.0 mm Hg [IQR, 77.6–135.7]; P=0.042). During prone positioning, the focal ARDS group showed a greater improvement in the PaO2/FiO2 ratio than the diffuse ARDS group (median, 55.8 mm Hg [IQR, 11.1–109.2] vs. 42.8 mm Hg [IQR, 11.6–83.2]); however, the difference was not significant (P=0.705). Among the PaO2/FiO2-matched cohort, there was no significant difference in change in PaO2/FiO2 ratio after prone positioning between the groups (P=0.904).Conclusions: In patients with moderate-to-severe ARDS, changes in PaO2/FiO2 ratio after prone positioning did not differ according to lung morphology. Therefore, prone positioning can be considered as soon as indicated, regardless of ARDS lung morphology.
Abstract
Background: There are limited data on the clinical effects of prone positioning according to lung morphology. We aimed to determine whether the gas exchange response to prone positioning differs according to lung morphology.Methods: This retrospective study included adult patients with moderate-to-severe acute respiratory distress syndrome (ARDS). The lung morphology of ARDS was assessed by chest computed tomography scan and classified as “diffuse” or “focal.” The primary outcome was change in partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio after the first prone positioning session: first, using the entire cohort, and second, using subgroups of patients with diffuse ARDS matched 2 to 1 with patients with focal ARDS at baseline.Results: Ninety-five patients were included (focal ARDS group, 23; diffuse ARDS group, 72). Before prone positioning, the focal ARDS group showed worse oxygenation than the diffuse ARDS group (median PaO2/FiO2 ratio, 79.9 mm Hg [interquartile range (IQR)], 67.7–112.6 vs. 104.0 mm Hg [IQR, 77.6–135.7]; P=0.042). During prone positioning, the focal ARDS group showed a greater improvement in the PaO2/FiO2 ratio than the diffuse ARDS group (median, 55.8 mm Hg [IQR, 11.1–109.2] vs. 42.8 mm Hg [IQR, 11.6–83.2]); however, the difference was not significant (P=0.705). Among the PaO2/FiO2-matched cohort, there was no significant difference in change in PaO2/FiO2 ratio after prone positioning between the groups (P=0.904).Conclusions: In patients with moderate-to-severe ARDS, changes in PaO2/FiO2 ratio after prone positioning did not differ according to lung morphology. Therefore, prone positioning can be considered as soon as indicated, regardless of ARDS lung morphology.
참고문헌 (32)
- Ashbaugh DG, "Acute respiratory distress in adults", Lancet, 2, pp.319~323 (1967)
- Acute Respiratory Distress Syndrome Network; Brower RG, "Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome", N Engl J Med, 342, pp.1301~1308 (2000)
- Hager DN, "Tidal volume reduction in patients with acute lung injury when plateau pressures are not high", Am J Respir Crit Care Med, 172, pp.1241~1245 (2005)
- Papazian L, "Neuromuscular blockers in early acute respiratory distress syndrome", N Engl J Med, 363, pp.1107~1116 (2010)
- Briel M, "Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome : systematic review and meta-analysis", JAMA, 303, pp.865~873 (2010)
- Guérin C, "Prone positioning in severe acute respiratory distress syndrome", N Engl J Med, 368, pp.2159~2168 (2013)
- Lee HY, "Improved oxygenation after prone positioning may be a predictor of survival in patients with acute respiratory distress syndrome", Crit Care Med, 48, pp.1729~1736 (2020)
- Scholten EL, "Treatment of ARDS with prone positioning", Chest, 151, pp.215~224 (2017)
- Reddy K, "Subphenotypes in critical care : translation into clinical practice", Lancet Respir Med, 8, pp.631~643 (2020)
- Calfee CS, "Subphenotypes in acute respiratory distress syndrome : latent class analysis of data from two randomised controlled trials", Lancet Respir Med, 2, pp.611~620 (2014)
- Constantin JM, "Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France(the LIVE study) : a multicentre, single-blind, randomised controlled trial", Lancet Respir Med, 7, pp.870~880 (2019)
- ARDS Definition Task Force, "Acute respiratory distress syndrome : the Berlin Definition", JAMA, 307, pp.2526~2533 (2012)
- Hu SL, "The effect of prone positioning on mortality in patients with acute respiratory distress syndrome : a meta-analysis of randomized controlled trials", Crit Care, 18, pp.R109~ (2014)
- Coppola S, "Radiological pattern in ARDS patients : partitioned respiratory mechanics, gas exchange and lung recruitability", Ann Intensive Care, 11, pp.78~ (2021)
- Costamagna A, "Clinical performance of lung ultrasound in predicting ARDS morphology", Ann Intensive Care, 11, pp.51~ (2021)
- Hao D, "Prone positioning of intubated patients with an elevated body-mass index", N Engl J Med, 386, pp.e34~ (2022)
- Schmidt M, "Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome. an international multicenter prospective cohort", Am J Respir Crit Care Med, 200, pp.1002~1012 (2019)
- Peduzzi P, "A simulation study of the number of events per variable in logistic regression analysis", J Clin Epidemiol, 49, pp.1373~1379 (1996)
- Gattinoni L, "Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome", Crit Care Med, 31, pp.2727~2733 (2003)
- Sjoding MW, "Interobserver reliability of the Berlin ARDS definition and strategies to improve the reliability of ARDS diagnosis", Chest, 153, pp.361~367 (2018)
- Bellani G, "Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries", JAMA, 315, pp.788~800 (2016)
- Rouby JJ, "Acute respiratory distress syndrome : lessons from computed tomography of the whole lung", Crit Care Med, 31(4 Suppl), pp.S285~S295 (2003)
- Chiumello D, "Low-dose chest computed tomography for quantitative and visual anatomical analysis in patients with acute respiratory distress syndrome", Intensive Care Med, 40, pp.691~699 (2014)
- Simon M, "Value of computed tomography of the chest in subjects with ARDS : a retrospective observational study", Respir Care, 61, pp.316~323 (2016)
- Richter T, "Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury", Am J Respir Crit Care Med, 172, pp.480~487 (2005)
- Petersson J, "Gas exchange and ventilation-perfusion relationships in the lung", Eur Respir J, 44, pp.1023~1041 (2014)
- Amato MB, "Driving pressure and survival in the acute respiratory distress syndrome", N Engl J Med, 372, pp.747~755 (2015)
- Balzer F, "Predictors of survival in critically ill patients with acute respiratory distress syndrome(ARDS) : an observational study", BMC Anesthesiol, 16, pp.108~ (2016)
- Song M, "Prognostic factors for ARDS : clinical, physiological and atypical immunodeficiency", BMC Pulm Med, 20, pp.102~ (2020)
- Wu Z, "Correlation between ground-glass opacity on pulmonary CT and the levels of inflammatory cytokines in patients with moderate-to-severe COVID-19 pneumonia", Int J Med Sci, 18, pp.2394~2400 (2021)
- Chen YY, "Prognostic value of computed tomographic findings in acute respiratory distress syndrome and the response to prone positioning", BMC Pulm Med, 22, pp.71~ (2022)
- Scaramuzzo G, "Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients : a cohort study", Ann Intensive Care, 11, pp.63~ (2021)