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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2024; 44:e1-e9. [PMID: 38295861 DOI: 10.4037/ccn2023201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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2
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Gemelli N, Sotera Lic G, Barrios C, Pina D, Carboni Bisso I, Las Heras M. [Feasibility of prone position with a single operator for low resources ICU: Step-by-step technical description]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:179-181. [PMID: 35261398 PMCID: PMC8895261 DOI: 10.1016/j.redar.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- N Gemelli
- Unidad de Cuidados Intensivos para Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Sotera Lic
- Unidad de Cuidados Intensivos para Adultos, Sanatorio Franchin, Buenos Aires, Argentina
| | - C Barrios
- Unidad de Cuidados Intensivos para Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Unidad de Cuidados Intensivos para Adultos, Sanatorio Franchin, Buenos Aires, Argentina
| | - D Pina
- Unidad de Cuidados Intensivos para Adultos, Sanatorio Franchin, Buenos Aires, Argentina
| | - I Carboni Bisso
- Unidad de Cuidados Intensivos para Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Unidad de Cuidados Intensivos para Adultos, Sanatorio Franchin, Buenos Aires, Argentina
| | - M Las Heras
- Unidad de Cuidados Intensivos para Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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3
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Gemelli N, Sotera Lic G, Barrios C, Pina D, Carboni Bisso I, Las Heras M. Feasibility of prone position with a single operator for low resources ICU: Step-by-step technical description. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:180-182. [PMID: 36842682 PMCID: PMC9957331 DOI: 10.1016/j.redare.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/08/2022] [Indexed: 02/28/2023]
Affiliation(s)
- N Gemelli
- Unidad de Cuidados Intensivos para Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - G Sotera Lic
- Unidad de Cuidados Intensivos para Adultos, Sanatorio Franchin, Buenos Aires, Argentina
| | - C Barrios
- Unidad de Cuidados Intensivos para Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Unidad de Cuidados Intensivos para Adultos, Sanatorio Franchin, Buenos Aires, Argentina
| | - D Pina
- Unidad de Cuidados Intensivos para Adultos, Sanatorio Franchin, Buenos Aires, Argentina
| | - I Carboni Bisso
- Unidad de Cuidados Intensivos para Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Unidad de Cuidados Intensivos para Adultos, Sanatorio Franchin, Buenos Aires, Argentina
| | - M Las Heras
- Unidad de Cuidados Intensivos para Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Morata L, Vollman K, Rechter J, Cox J. Manual Prone Positioning in Adults: Reducing the Risk of Harm Through Evidence-Based Practices. Crit Care Nurse 2023; 43:59-66. [PMID: 36720277 DOI: 10.4037/ccn2023174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Dubosh NM, Wong ML, Grossestreuer AV, Loo YK, Sanchez LD, Chiu D, Leventhal EL, Ilg A, Donnino MW. Early, awake proning in emergency department patients with COVID-19. Am J Emerg Med 2020; 46:640-645. [PMID: 33309507 PMCID: PMC7713606 DOI: 10.1016/j.ajem.2020.11.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 12/30/2022] Open
Abstract
Objective Proning has been shown to improve oxygenation and mortality in certain populations of intubated patients with acute respiratory distress syndrome. Small observational analyses of COVID-19 patients suggest awake proning may lead to clinical improvement. Data on safety and efficacy is lacking. We sought to describe the effect of proning on oxygenation in nonintubated COVID-19 patients. We also evaluated feasibility, safety, and other physiological and clinical outcomes associated with this intervention. Methods We conducted a prospective, observational cohort study of nonintubated patients with COVID-19 who underwent proning per an Emergency Department (ED) clinical protocol. Patients with mild to moderate respiratory distress were included. We calculated change in oxygenation by comparing the oxygen saturation to fraction of inspired oxygen ratio (SpO2:FiO2) during the five minutes prior to proning and first 30 min of proning. We also captured data on respiratory rate, duration of proning, need for intubation, intensive care unit admission, survival to discharge. Results Fifty-two patients were enrolled. Thirty were excluded for not meeting protocol inclusion criteria or missing baseline oxygenation data, leaving 22 for analysis. The SpO2:FiO2 ratio increased by a median of 5 (IQR: 0–15) in the post-proning period compared to the pre-proning period (median: 298 (IQR: 263–352) vs 295 (IQR: 276–350), p = 0.01). Respiratory rate did not change significantly between time periods. No immediate adverse events occurred during proning. Five patients (23%) were intubated within 48 h of admission. Conclusion Early, awake proning may be feasible in select COVID-19 patients and was associated with improved oxygenation.
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Affiliation(s)
- Nicole M Dubosh
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America.
| | - Matthew L Wong
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Anne V Grossestreuer
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Ying K Loo
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - David Chiu
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Evan L Leventhal
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Annette Ilg
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America; Division of Pulmonary/Critical Care, Department of Internal Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
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Wiggermann N, Zhou J, Kumpar D. Proning Patients With COVID-19: A Review of Equipment and Methods. HUMAN FACTORS 2020; 62:1069-1076. [PMID: 32845730 PMCID: PMC7586000 DOI: 10.1177/0018720820950532] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/20/2020] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To identify and critically evaluate methods for proning patients with COVID-19 in the intensive care unit (ICU). BACKGROUND Acute respiratory distress syndrome (ARDS) is common in hospitalized patients with COVID-19. Proning improves blood oxygenation and survival rates in these patients but is not commonly performed due to the difficulty of the procedure. METHODS An academic literature review, internet video search, and consultation with five subject-matter experts was performed to identify known methods for proning. Evaluation of each method considered the number of healthcare workers required, physical stresses on staff, risk of adverse events to patients, and equipment cost and availability. RESULTS Several variations of manual techniques and-lift assisted techniques were identified in addition to a specialized proning bed. Manual methods require more healthcare workers, higher physical stresses, and greater risk of adverse events than lift-assisted methods or the proning bed. CONCLUSION Both the specialized proning bed and a lift-assisted method using straps largely eliminated manual forces required for proning while allowing for a controlled lowering and positioning of the patient. APPLICATION This review will guide practitioners to the most suitable methods for proning patients in the ICU.
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Affiliation(s)
| | - Jie Zhou
- Hillrom, Batesville, Indiana, USA
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Valesky W, Chow L. Prone Positioning for Acute Respiratory Distress Syndrome in Adults. Acad Emerg Med 2020; 27:520-522. [PMID: 32096893 DOI: 10.1111/acem.13948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Walter Valesky
- From the Department of Emergency Medicine Kings County Hospital—NYC Health + Hospitals Brooklyn NY
| | - Lillian Chow
- and the Department of Medicine Division of Pulmonary and Critical Care Medicine SUNY Downstate Health Sciences University Brooklyn NY
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8
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Cannon JW, Gutsche JT, Brodie D. Optimal Strategies for Severe Acute Respiratory Distress Syndrome. Crit Care Clin 2017; 33:259-275. [PMID: 28284294 DOI: 10.1016/j.ccc.2016.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute respiratory distress syndrome (ARDS) occurs in more than 10% of intensive care unit admissions and in nearly 25% of ventilated patients. Mortality remains high at 40%, and, for patients who survive, recovery continues for months or even years. Early recognition and minimizing further lung injury remain essential to successful management of severe ARDS. Advanced treatment strategies, which complement lung protective ventilation, include short-term neuromuscular blockade, prone positioning, and extracorporeal membrane oxygenation. Alternative ventilator strategies include high-frequency ventilation and airway pressure release ventilation. This article reviews these options in patients with severe ARDS.
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Affiliation(s)
- Jeremy W Cannon
- Division of Trauma, Surgical Critical Care & Emergency Surgery, The Perelman School of Medicine at the University of Pennsylvania, 51 North 39th Street, MOB Suite 120, Philadelphia, PA 19104, USA.
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, The Perelman School of Medicine at the University of Pennsylvania, 51 North 39th Street, Philadelphia, PA 19104, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, & Critical Care Medicine, Columbia University Medical Center, 622 West 168 Street, PH 8 East, Room 101, New York, NY 10032, USA
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Oliveira VMD, Weschenfelder ME, Deponti G, Condessa R, Loss SH, Bairros PM, Hochegger T, Daroncho R, Rubin B, Chisté M, Batista DCR, Bassegio DM, Nauer WDS, Piekala DM, Minossi SD, Santos VFDRD, Victorino J, Vieira SRR. Good practices for prone positioning at the bedside: Construction of a care protocol. Rev Assoc Med Bras (1992) 2017; 62:287-93. [PMID: 27310555 DOI: 10.1590/1806-9282.62.03.287] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 12/01/2015] [Indexed: 11/22/2022] Open
Abstract
Last year, interest in prone positioning to treat acute respiratory distress syndrome (ARDS) resurfaced with the demonstration of a reduction in mortality by a large randomized clinical trial. Reports in the literature suggest that the incidence of adverse events is significantly reduced with a team trained and experienced in the process. The objective of this review is to revisit the current evidence in the literature, discuss and propose the construction of a protocol of care for these patients. A search was performed on the main electronic databases: Medline, Lilacs and Cochrane Library. Prone positioning is increasingly used in daily practice, with properly trained staff and a well established care protocol are essencial.
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Affiliation(s)
- Vanessa Martins de Oliveira
- Hospital de Clínicas de Porto Alegre, Multidisciplinary Group of Teaching and Research, Porto Alegre RS , Brazil, MD - Intensive Care Unit, Coordinator of the Multidisciplinary Group of Teaching and Research in PRONE of the Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Michele Elisa Weschenfelder
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, Undergraduate Diploma Nurse at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Gracieli Deponti
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, MSc Physiotherapist at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Robledo Condessa
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, MSc Physiotherapist at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Sergio Henrique Loss
- Hospital de Clínicas de Porto Alegre, Porto Alegre RS , Brazil, PhD Intensive Care Physician and Nutrologist, HCPA, Porto Alegre, RS, Brazil
| | - Patrícia Maurello Bairros
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, Undergraduate Diploma Nurse at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Thais Hochegger
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, Undergraduate Diploma Nurse at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Rogério Daroncho
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, Undergraduate Diploma Nurse at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Bibiana Rubin
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, Undergraduate Diploma Nutritionist at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Marcele Chisté
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, Undergraduate Diploma Nurse at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Danusa Cassiana Rigo Batista
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, Undergraduate Diploma Nurse at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Deise Maria Bassegio
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, Undergraduate Diploma Nurse at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Wagner da Silva Nauer
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, MSc Physiotherapist at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Daniele Martins Piekala
- Hospital de Clínicas de Porto Alegre, Porto Alegre RS , Brazil, PhD Intensive Care Physician and Nutrologist, HCPA, Porto Alegre, RS, Brazil
| | - Silvia Daniela Minossi
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, Undergraduate Diploma Nutritionist at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Vanessa Fumaco da Rosa Dos Santos
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, Undergraduate Diploma Physiotherapist at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Josue Victorino
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, PhD Physician at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
| | - Silvia Regina Rios Vieira
- Hospital de Clínicas de Porto Alegre, Intensive Care Unit, Porto Alegre RS , Brazil, PhD Supervising Physician at the Intensive Care Unit, HCPA, Porto Alegre, RS, Brazil
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Abstract
The management of acute respiratory failure varies according to the etiology. A clear understanding of physiology of respiration and pathophysiological mechanisms of respiratory failure is mandatory for managing these patients. The extent of abnormality in arterial blood gas values is a result of the balance between the severity of disease and the degree of compensation by cardiopulmonary system. Normal blood gases do not mean that there is an absence of disease because the homeostatic system can compensate. However, an abnormal arterial blood gas value reflects uncompensated disease that might be life threatening.
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Mase K, Tagami M, Imura S, Tomita K, Monma M, Nozoe M, Takashima Y. Regional lung volume differences between the side-lying and semi-prone positions. J Phys Ther Sci 2016; 28:1020-5. [PMID: 27134405 PMCID: PMC4842417 DOI: 10.1589/jpts.28.1020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/15/2015] [Indexed: 01/04/2023] Open
Abstract
[Purpose] This study aimed to clarify the differences in regional lung volume between the semi-prone (Sim's position) and side-lying position, and the optimal position for increasing lung volume. [Methods] Measurements were performed in both positions on both sides. Sim's position was inclined 45° forward from the side-lying position. A 1.5-T system with a fast advanced spin-echo sequence in the coronal plane was used for magnetic resonance imaging. [Results] The two positions did not significantly differ in total lung capacity and its subdivisions on both sides, except the left lung in the right side-lying position and right Sim's position. In the nondependent lung, the percentage lung volume of the dorsal segment was significantly higher in the right Sim's position than in the right side-lying position. However, no significant difference was observed between the left side-lying and left Sim's position. [Conclusion] The heart was displaced ventrally by gravity in Sim's position and leaned on the ventral parapet. The spaces for the expansion of the ventral and dorsal segments of the lung were decreased and increased in Sim's position, respectively. With a nondependent left lung, the increase in the percentage lung volume of the dorsal segment was greater in Sim's position than in the side-lying position.
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Affiliation(s)
- Kyoushi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
| | - Miki Tagami
- Department of Physical Therapy, Uekusa Gakuen University, Japan
| | - Shigeyuki Imura
- Department of Physical Therapy, Uekusa Gakuen University, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Masahiko Monma
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Japan
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
| | - Yukie Takashima
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
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12
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Management of refractory hypoxemia during venovenous extracorporeal membrane oxygenation for ARDS. ASAIO J 2016; 61:227-36. [PMID: 25923575 DOI: 10.1097/mat.0000000000000207] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Venovenous extracorporeal membrane oxygenation (VV ECMO) in acute respiratory distress syndrome (ARDS) is currently a widely used therapeutic strategy. However, patients are often still hypoxemic despite complete ECMO support. The major determinants of peripheral oxygen saturation (SpO2) during VV ECMO are pump flow, degree of recirculation, patient's systemic venous return and its oxygen saturation, hemoglobin concentration and residual lung function. Current guidelines state that the support can be considered adequate when the patient's SpO2 is equal or greater than 80%, but a possible objection could be that such a value of O2-tension may be too low and may worsen the patient's prognosis. Moving from the pathophysiology of hypoxemia during VV ECMO, this review focuses on recirculation of blood and on the possible strategies to minimize it, on the pharmacologic modulation of intrapulmonary shunt and on the questions related to management of ECMO flow and the risks and benefits of permissive hypoxemic states. Transfusional strategy during VV ECMO, administration of neuromuscular blocking agents and sedatives, therapeutic hypothermia, and prone positioning is also reviewed. The potential advantages of β-blockers are discussed. Finally, transition from VV ECMO to venoarterial ECMO (VA ECMO) or a hybrid configuration is also examined.
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Mora-Arteaga JA, Bernal-Ramírez OJ, Rodríguez SJ. The effects of prone position ventilation in patients with acute respiratory distress syndrome. A systematic review and metaanalysis. Med Intensiva 2015; 39:359-72. [PMID: 25599942 DOI: 10.1016/j.medin.2014.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/26/2014] [Accepted: 11/04/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Prone position ventilation has been shown to improve oxygenation and ventilatory mechanics in patients with acute respiratory distress syndrome. We evaluated whether prone ventilation reduces the risk of mortality in adult patients with acute respiratory distress syndrome versus supine ventilation. METHODOLOGY A metaanalysis of randomized controlled trials comparing patients in supine versus prone position was performed. A search was conducted of the Pubmed, Embase, Cochrane Library, and LILACS databases. Mortality, hospital length of stay, days of mechanical ventilation and adverse effects were evaluated. RESULTS Seven randomized controlled trials (2,119 patients) were included in the analysis. The prone position showed a nonsignificant tendency to reduce mortality (OR: 0.76; 95%CI: 0.54 to 1.06; P=.11, I(2) 63%). When stratified by subgroups, a significant decrease was seen in the risk of mortality in patients ventilated with low tidal volume (OR: 0.58; 95%CI: 0.38 to 0.87; P=.009, I(2) 33%), prolonged pronation (OR: 0.6; 95%CI: 0.43 to 0.83; p=.002, I(2) 27%), start within the first 48hours of disease evolution (OR 0.49; 95%CI 0.35 to 0.68; P=.0001, I(2) 0%) and severe hypoxemia (OR: 0.51: 95%CI: 0.36 to 1.25; P=.0001, I(2) 0%). Adverse effects associated with pronation were the development of pressure ulcers and endotracheal tube obstruction. CONCLUSIONS Prone position ventilation is a safe strategy and reduces mortality in patients with severely impaired oxygenation. It should be started early, for prolonged periods, and should be associated to a protective ventilation strategy.
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Affiliation(s)
- J A Mora-Arteaga
- Medicina Crítica y Cuidado Intensivo, Universidad del Rosario, Fundación Santa Fe de Bogotá-Hospital Universitario, Bogotá D.C., Colombia.
| | - O J Bernal-Ramírez
- Medicina Crítica y Cuidado Intensivo, Clínica Nueva-Hospital de Suba, Bogotá D.C., Colombia
| | - S J Rodríguez
- Medicina Crítica y Cuidado Intensivo, Clínica Nueva-Hospital Universitario la Samaritana, Bogotá D.C., Colombia
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Hou S, Ding H, Lv Q, Yin X, Song J, Landén NX, Fan H. Therapeutic effect of intravenous infusion of perfluorocarbon emulsion on LPS-induced acute lung injury in rats. PLoS One 2014; 9:e87826. [PMID: 24489970 PMCID: PMC3905038 DOI: 10.1371/journal.pone.0087826] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 12/31/2013] [Indexed: 11/21/2022] Open
Abstract
Acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS) are the leading causes of death in critical care. Despite extensive efforts in research and clinical medicine, mortality remains high in these diseases. Perfluorocarbon (PFC), a chemical compound known as liquid ventilation medium, is capable of dissolving large amounts of physiologically important gases (mainly oxygen and carbon dioxide). In this study we aimed to investigate the effect of intravenous infusion of PFC emulsion on lipopolysaccharide (LPS) induced ALI in rats and elucidate its mechanism of action. Forty two Wistar rats were randomly divided into three groups: 6 rats were treated with saline solution by intratracheal instillation (control group), 18 rats were treated with LPS by intratracheal instillation (LPS group) and the other 18 rats received PFC through femoral vein prior to LPS instillation (LPS+PFC group). The rats in the control group were sacrificed 6 hours later after saline instillation. At 2, 4 and 6 hours of exposure to LPS, 6 rats in the LPS group and 6 rats in LPS+PFC group were sacrificed at each time point. By analyzing pulmonary pathology, partial pressure of oxygen in the blood (PaO2) and lung wet-dry weight ratio (W/D) of each rat, we found that intravenous infusion of PFC significantly alleviated acute lung injury induced by LPS. Moreover, we showed that the expression of pulmonary myeloperoxidase (MPO), intercellular adhesion molecule-1 (ICAM-1) of endothelial cells and CD11b of polymorphonuclear neutrophils (PMN) induced by LPS were significantly decreased by PFC treatment in vivo. Our results indicate that intravenous infusion of PFC inhibits the infiltration of PMNs into lung tissue, which has been shown as the core pathogenesis of ALI/ARDS. Thus, our study provides a theoretical foundation for using intravenous infusion of PFC to prevent and treat ALI/ARDS in clinical practice.
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Affiliation(s)
- Shike Hou
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
| | - Hui Ding
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
| | - Qi Lv
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
| | - Xiaofeng Yin
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
| | - Jianqi Song
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
| | - Ning Xu Landén
- Molecular Dermatology Research Group, Center for Molecular Medicine (CMM), Karolinska University Hospital, Stockholm, Sweden
| | - Haojun Fan
- Rescue Medical Research Institute, Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces, Tianjin, P.R. China
- * E-mail:
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15
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Abstract
Complications following esophagectomy significantly affect the outcome, including perioperative mortality, costs and survival. Pulmonary complications and anastomotic leaks still remain the most serious complications and early recognition and appropriate initial treatment are essential. Mortality associated with esophageal leaks is decreasing due in part to the increased use of computed tomography (CT) scanning and endoscopy for diagnosis and subsequent appropriate multidisciplinary therapy. In this respect, it is critically important to differentiate between leaks and conduit necrosis, and endoscopic examination is the best method for making this assessment. Endoscopic and interventional radiology techniques are being applied increasingly for detection of intrathoracic leaks but appropriate patient selection is important. Adequate external drainage of the leak and prevention of further contamination are the primary therapeutic goals. The spectrum of therapeutic options ranges from simple conservative treatment for smaller, well drained leaks, interventional placement of drains, to endoscopic intervention with closure of the fistula or placement of stents and reoperation or discontinuity resection for conduit necrosis.
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16
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Qureshi A, Cornwell C. Effectiveness of Prone Ventilation in patients with Acute Respiratory Distress Syndrome: a systematic review. ACTA ACUST UNITED AC 2012; 10:1-12. [PMID: 27820146 DOI: 10.11124/jbisrir-2012-176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Abdul Qureshi
- a Physician-Critical Care Medicine 1. INTEGRIS Baptist Medical Center, The Joanna Briggs Institute of Oklahoma,
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