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Cai H, Luo S, Cai X, Lai T, Zhao S, Zhang W, Zhuang J, Li Z, Chen L, Chen B, Ye Y. Effect of Fu Zheng Jie Du Formula on outcomes in patients with severe pneumonia receiving prone ventilation: a retrospective cohort study. Front Pharmacol 2024; 15:1428817. [PMID: 39114366 PMCID: PMC11303160 DOI: 10.3389/fphar.2024.1428817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/01/2024] [Indexed: 08/10/2024] Open
Abstract
Background The effect of combining prone ventilation with traditional Chinese medicine on severe pneumonia remains unclear. Objective To evaluate the effect of Fu Zheng Jie Du Formula (FZJDF) combined with prone ventilation on clinical outcomes in patients with severe pneumonia. Methods This single-center retrospective cohort study included 188 severe pneumonia patients admitted to the ICU from January 2022 to December 2023. Patients were divided into an FZJD group (receiving FZJDF for 7 days plus prone ventilation) and a non-FZJD group (prone ventilation only). Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was the change in PaO2/FiO2 ratio after treatment. Secondary outcomes included 28-day mortality, duration of mechanical ventilation, length of ICU stay, PaCO2, lactic acid levels, APACHE II score, SOFA score, Chinese Medicine Score, inflammatory markers, and time to symptom resolution. Results After PSM, 32 patients were included in each group. Compared to the non-FZJD group, the FZJD group showed significantly higher PaO2/FiO2 ratios, lower PaCO2, and lower lactic acid levels after treatment (p < 0.05 for all). The FZJD group also had significantly lower APACHE II scores, SOFA scores, Chinese Medicine Scores, and levels of WBC, PCT, hs-CRP, and IL-6 (p < 0.05 for all). Time to symptom resolution, including duration of mechanical ventilation, length of ICU stay, time to fever resolution, time to cough resolution, and time to resolution of pulmonary rales, was significantly shorter in the FZJD group (p < 0.05 for all). There was no significant difference in 28-day mortality between the two groups. Conclusion FZJDF as an adjuvant therapy to prone ventilation can improve oxygenation and other clinical outcomes in severe pneumonia patients. Prospective studies are warranted to validate these findings.
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Affiliation(s)
- Hairong Cai
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sicong Luo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xingui Cai
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Lai
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuai Zhao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research on Emergency in Traditional Chinese Medicine, Guangzhou, China
| | - Weizhang Zhang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jieqin Zhuang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhishang Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bojun Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research on Emergency in Traditional Chinese Medicine, Guangzhou, China
- Clinical Research Team of Prevention and Treatment of Cardiac Emergencies with Traditional Chinese Medicine, Guangzhou, China
| | - Ye Ye
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research on Emergency in Traditional Chinese Medicine, Guangzhou, China
- Clinical Research Team of Prevention and Treatment of Cardiac Emergencies with Traditional Chinese Medicine, Guangzhou, China
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Flow phenomenon, a differential diagnosis in refractory hypoxaemia in patients with anterior mediastinal mass. Case report☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201712001-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Laverde-Sabogal CE, Espinosa-Almanza CJ. Fenómeno de flujo, diagnóstico diferencial de la hipoxemia refractaria en pacientes con masa mediastinal anterior. Reporte de caso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Flow phenomenon, a differential diagnosis in refractory hypoxaemia in patients with anterior mediastinal mass. Case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2016.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mobley SR, Miller BT, Astor FC, Fine B, Halliday NJ. Prone positioning for head and neck reconstructive surgery. Head Neck 2008; 29:1041-5. [PMID: 17712853 DOI: 10.1002/hed.20650] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Certain head and neck surgical cases require the patient to be positioned prone. Such positioning carries with it an attendant subset of risks and complications not otherwise encountered in more traditional supine positioning. Gaining awareness of these risks and complications, and developing proactive positioning strategies, will enable the surgical team to position the patient optimally for the procedure and provide for every consideration of patient safety. This article consists of a specific literature review of those issues directly related to the anatomical and physiological concerns arising from prone positioning. Particular attention is paid to the cardiopulmonary, renal, ophthalmologic, and neurological vulnerabilities unique to this position. Proper planning by the surgical team and utilization of the correct equipment are a necessity. A tailored approach to the needs of the individual patient and an intimate awareness of the potential pitfalls will contribute to better outcomes when using the prone position.
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Affiliation(s)
- Steven Ross Mobley
- Division of Otolaryngology, Department of Surgery, University of Utah, 50 N. Medical Drive, 3C-120, Salt Lake City, Utah 84107, USA.
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Nakos G, Batistatou A, Galiatsou E, Konstanti E, Koulouras V, Kanavaros P, Doulis A, Kitsakos A, Karachaliou A, Lekka ME, Bai M. Lung and 'end organ' injury due to mechanical ventilation in animals: comparison between the prone and supine positions. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R38. [PMID: 16507176 PMCID: PMC1550810 DOI: 10.1186/cc4840] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 01/25/2006] [Accepted: 02/03/2006] [Indexed: 02/06/2023]
Abstract
Introduction Use of the prone position in patients with acute lung injury improves their oxygenation. Most of these patients die from multisystem organ failure and not from hypoxia, however. Moreover, there is some evidence that the organ failure is caused by increased cell apoptosis. In the present study we therefore examined whether the position of the patients affects histological changes and apoptosis in the lung and 'end organs', including the brain, heart, diaphragm, liver, kidneys and small intestine. Methods Ten mechanically ventilated sheep with a tidal volume of 15 ml/kg body weight were studied for 90 minutes. Five sheep were placed in the supine position and five sheep were placed in the prone position during the experiment. Lung changes were analyzed histologically using a semiquantitative scoring system and the extent of apoptosis was investigated with the TUNEL method. Results In the supine position intra-alaveolar hemorrhage appeared predominantly in the dorsal areas, while the other histopathologic lesions were homogeneously distributed throughout the lungs. In the prone position, all histological changes were homogeneously distributed. A significantly higher score of lung injury was found in the supine position than in the prone position (4.63 ± 0.58 and 2.17 ± 0.19, respectively) (P < 0.0001). The histopathologic changes were accompanied by increased apoptosis (TUNEL method). In the supine position, the apoptotic index in the lung and in most of the 'end organs' was significantly higher compared with the prone position (all P < 0.005). Interestingly, the apoptotic index was higher in dorsal areas compared with ventral areas in both the prone and supine positions (P < 0.003 and P < 0.02, respectively). Conclusion Our results suggest that the prone position appears to reduce the severity and the extent of lung injury, and is associated with decreased apoptosis in the lung and 'end organs'.
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Affiliation(s)
- George Nakos
- Department of Intensive Care Unit, University Hospital of Ioannina, Greece
| | | | - Eftychia Galiatsou
- Department of Intensive Care Unit, University Hospital of Ioannina, Greece
| | - Eleonora Konstanti
- Department of Intensive Care Unit, University Hospital of Ioannina, Greece
| | | | | | - Apostolos Doulis
- Department of Intensive Care Unit, University Hospital of Ioannina, Greece
| | | | | | | | - Maria Bai
- Department of Pathology, University of Ioannina, Greece
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Lin FC, Chen YC, Chang HI, Chang SC. Effect of Body Position on Gas Exchange in Patients With Idiopathic Pulmonary Alveolar Proteinosis. Chest 2005; 127:1058-64. [PMID: 15764795 DOI: 10.1378/chest.127.3.1058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Prone positioning may improve oxygenation in patients with acute lung injury/ARDS. However, the beneficial effect of prone positioning on gas exchange has never been investigated in patients with diffuse pulmonary infiltrates who breathe spontaneously. OBJECTIVE To evaluate the effect of body position on gas exchange in patients with idiopathic pulmonary alveolar proteinosis (PAP) with special reference to the benefit of prone positioning. DESIGN A prospective study. SETTING Tertiary medical center. PATIENTS AND METHODS Eight patients with PAP were studied on 25 occasions using spirometry, body plethysmography, and single-breath diffusing capacity of the lung for carbon monoxide (Dlco). Arterial blood gas levels were measured in the sitting position and in four lying positions randomly while patients breathed room air. To serve as control subjects, 16 age-matched healthy hospital personnel were studied. To evaluate the impact of oxygen therapy on positional effect in gas exchange, arterial blood gas levels were measured in the supine and prone positions in some PAP patients while breathing 40% oxygen. RESULTS Normal to varying degrees of restrictive ventilatory defect and gas exchange impairment, as evidenced by Dlco, Pao(2), and alveolar-arterial oxygen pressure difference (P[A-a]O(2)), were found in PAP patients. The ventilatory function parameters correlated positively with Pao(2) and negatively with P(A-a)O(2). The values of Pao(2) and P(A-a)O(2) measured in four lying positions showed no significant difference in both PAP patients and healthy control subjects. Furthermore, the differences in Pao(2) and P(A-a)O(2) between measurements made in the supine and prone positions and the ratio of Pao(2) measured in the prone position/Pao(2) measured in the supine position were comparable between PAP patients and healthy control subjects. Arterial blood gas levels showed no significant difference between measurements made in PAP patients in the supine and prone positions while breathing 40% oxygen. CONCLUSIONS Positional change did not significantly affect gas exchange, and no benefit of prone positioning was found in both PAP patients and healthy control subjects. Further studies are needed to verify the benefit of prone ventilation in patients with diffuse pulmonary disorders who breathe spontaneously.
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Affiliation(s)
- Fang-Chi Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Valter C, Christensen AM, Tollund C, Schønemann NK. Response to the prone position in spontaneously breathing patients with hypoxemic respiratory failure. Acta Anaesthesiol Scand 2003; 47:416-8. [PMID: 12694139 DOI: 10.1034/j.1399-6576.2003.00088.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The prone position is used for intubated patients with adult respiratory distress syndrome (ARDS) and acute lung injury (ALI). The physiological changes associated with the prone position in nonintubated patients may be even more favorable than in intubated patients. We examined the effect of the prone position on arterial blood gases and patient compliance in four awake, nonintubated patients with hypoxemic respiratory failure. DESIGN We present four consecutive cases of hypoxemic respiratory failure, in which mechanical ventilation was indicated. An attempt was made to avoid assisted ventilation by placing patients in the prone position, while breathing spontaneously. The effect on the clinical condition and the changes in blood gases were registered. RESULTS We found good patient tolerance. A rapid increase in PaO2 was found, and intubation was avoided in all patients. No significant complications were registered. CONCLUSION The prone position may prove beneficial in some cases of hypoxemic respiratory failure, even in awake patients, by avoiding mechanical ventilation and ventilator-associated complications.
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Affiliation(s)
- C Valter
- Department of Anesthesiology and Intensive Care, University of Copenhagen, Copenhagen, Denmark.
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Rabb H, Wang Z, Nemoto T, Hotchkiss J, Yokota N, Soleimani M. Acute renal failure leads to dysregulation of lung salt and water channels. Kidney Int 2003; 63:600-6. [PMID: 12631124 DOI: 10.1046/j.1523-1755.2003.00753.x] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Renal ischemia/reperfusion (I/R) injury and the acute respiratory distress syndrome (ARDS) frequently coexist in the intensive care setting, and this combination is associated with a high mortality. Recent experimental data demonstrate that renal I/R injury leads to an increase in pulmonary vascular permeability, similar to that observed in ARDS. However, the effects of renal I/R injury on alveolar fluid clearance-of potential importance in the setting of increased permeability-are unknown. We investigated the effects of renal I/R injury on pulmonary epithelial sodium channel (ENaC), Na,K-ATPase and aquaporin expression as a first step in addressing this question. METHODS Sprague Dawley rats were subjected to four protocols: (1) surgery for bilateral I/R injury, (2) sham surgery, (3) surgery for unilateral I/R injury, or (4) bilateral nephrectomy. Lung tissue was examined for Na channel, Na,K-ATPase, aquaporin-1, and aquaporin-5 expression. Northern and Western blots were performed. RESULTS Renal I/R injury and bilateral nephrectomy both led to marked down-regulation of pulmonary ENaC, Na,K-ATPase and aquaporin-5 but not aquaporin-1 compared to sham surgery. These changes were not influenced by the animals' volume status. In contrast, unilateral I/R with an intact contralateral kidney did not lead to down-regulation of channel down-regulation. CONCLUSIONS Ischemic acute renal failure leads to down regulation of pulmonary ENaC, Na,K-ATPase and aquaporin-5, but not aquaporin-1. Since bilateral nephrectomy but not single kidney I/R injury also leads to lung changes, these changes are likely mediated by systemic effects of acute renal failure (ARF), such as "uremic toxins," rather than reperfusion products. These changes may modulate lung dysfunction, susceptibility to lung injury, or both.
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Affiliation(s)
- Hamid Rabb
- Nephrology Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Abstract
Severe respiratory failure in newborn and pediatric patients is associated with significant morbidity and mortality. Basic science laboratory investigation has led to advances in the understanding of ventilator-induced lung injury and in optimizing the supportive use of conventional ventilation strategies. Over the past few years, progress has been made in alternative therapies for supporting children and adults with severe respiratory failure. This review will focus on recent laboratory and clinical data regarding the techniques of lung protective ventilator strategies, inhaled nitric oxide, liquid ventilation, and extracorporeal life support (ECLS, ECMO). Some of these modalities are commonplace, while others may have much to offer the pediatric clinician if their benefit is clearly demonstrated in future clinical trials.
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Affiliation(s)
- Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
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11
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Abstract
Increased knowledge of the pathophysiologic mechanisms of impaired gas exchange during acute respiratory failure during recent years has stimulated many studies that evaluate different treatments to improve oxygenation and outcome. Changes in body position (mainly prone positioning) can significantly improve gas exchange in patients with acute respiratory distress syndrome and acute lung failure, with few complications related to the maneuver; however, no survival advantage has yet been detected. A correlation between aerated lung tissue and oxygenation also confirms the importance of recruitment maneuvers in improving gas exchange. Recent suggestions that recruitment of alveoli proceeds during most of the inspired vital capacity and not only around the lower inflection point of the pressure-volume curve raises the question how to best perform recruitment maneuvers. New data support the hypothesis that maintenance of even small amount of spontaneous breathing during mechanical ventilation (with airway pressure release ventilation or biphasic positive airway pressure) can improve gas exchange, whereas other unconventional ventilatory modes have not yet proved advantageous. Some mechanisms responsible for the high percentage of nonresponse to inhaled nitric oxide have recently been proposed, and combinations of inhaled nitric oxide with other therapies have been tested. Increased knowledge in this area may, in the future, make inhaled nitric oxide more attractive in the treatment of adult respiratory failure as well as in neonatal intensive care.
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Affiliation(s)
- Göran Hedenstierna
- Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala, Sweden.
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George EL, Hoffman LA, Boujoukos A, Zullo TG. Effect of Positioning on Oxygenation in Single-Lung Transplant Recipients. Am J Crit Care 2002. [DOI: 10.4037/ajcc2002.11.1.66] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Many benefits and adverse effects of positioning are related to changes in ventilation and perfusion. A number of unique factors related to the allograft make the effects of positioning difficult to determine in single-lung transplant recipients.• Objectives To determine the effect of 3 body positions (supine, lateral with allograft lung down, and lateral with native lung down) on oxygenation and blood flow in single-lung transplant recipients in the 24 hours immediately after surgery.• Methods A quasi-experimental repeated-measures design with stratified assignment to 1 of 3 different sequencing patterns for turning group was used to study 15 transplant recipients, 9 with emphysema and 6 with fibrosis. Oxygenation, ventilation, and blood flow measures (heart rate, blood pressure) were assessed after each turn. The effect of ischemic reperfusion injury was also explored.• Results The oxygenation, ventilation, and blood flow variables did not differ significantly across group, diagnosis, or time. Oxygenation variables measured when the allograft lung was dependent did not differ significantly from such measurements obtained when the native lung was dependent.• Conclusions No single position maximizes oxygenation in the immediate postoperative period in single-lung transplant recipients. Although a single standard protocol for positioning cannot be supported, the study does support the idea that transplant recipients can be safely turned in the immediate postoperative period without compromising oxygenation or hemodynamic status.
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Affiliation(s)
- Elisabeth L. George
- The University of Pittsburgh Health System (ELG), University of Pittsburgh School of Nursing (LAH, TGZ), and University of Pittsburgh School of Medicine (AB), Pittsburgh, Pa
| | - Leslie A. Hoffman
- The University of Pittsburgh Health System (ELG), University of Pittsburgh School of Nursing (LAH, TGZ), and University of Pittsburgh School of Medicine (AB), Pittsburgh, Pa
| | - Arthur Boujoukos
- The University of Pittsburgh Health System (ELG), University of Pittsburgh School of Nursing (LAH, TGZ), and University of Pittsburgh School of Medicine (AB), Pittsburgh, Pa
| | - Thomas G. Zullo
- The University of Pittsburgh Health System (ELG), University of Pittsburgh School of Nursing (LAH, TGZ), and University of Pittsburgh School of Medicine (AB), Pittsburgh, Pa
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Abstract
Improved understanding of the pathogenesis of acute lung injury (ALI)/ARDS has led to important advances in the treatment of ALI/ARDS, particularly in the area of ventilator-associated lung injury. Standard supportive care for ALI/ARDS should now include a protective ventilatory strategy with low tidal volume ventilation by the protocol developed by the National Institutes of Health ARDS Network. Further refinements of the protocol for mechanical ventilation will occur as current and future clinical trials are completed. In addition, novel modes of mechanical ventilation are being studied and may augment standard therapy in the future. Although results of anti-inflammatory strategies have been disappointing in clinical trials, further trials are underway to test the efficacy of late corticosteroids and other approaches to modulation of inflammation in ALI/ARDS.
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Affiliation(s)
- R G Brower
- Johns Hopkins University, Baltimore, MD, USA
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