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Minerva Anestesiologica Nov 2012Several recent studies have advanced our understanding of dead-space ventilation in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). They... (Review)
Review
Several recent studies have advanced our understanding of dead-space ventilation in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). They have demonstrated the utility of measuring physiologic dead-space-to-tidal volume ratio (VD/VT) and related variables in assessing outcomes as well as therapeutic interventions. These studies have included the evaluation of mortality risk, pulmonary perfusion, as well as the effectiveness of drug therapy, prone positioning, positive end-expiratory pressure (PEEP) titration, and inspiratory pattern in improving gas exchange. In patients with ALI/ARDS managed with lung-protective ventilation a significant relationship between elevated VD/VT and increased mortality continues to be reported in both early and intermediate phases of ALI/ARDS. Some clinical evidence now supports the suggestion that elevated VD/VT in part reflects the severity of pulmonary vascular endothelial damage. Monitoring VD/VT also appears useful in assessing alveolar recruitment when titrating PEEP and may be a particularly expedient method for assessing the effectiveness of prone positioning. It also has revealed how subtle manipulations of inspiratory time and pattern can improve CO(2) excretion. Much of this has been accomplished using volumetric capnography. This allows for more sophisticated measurements of pulmonary gas exchange function including: alveolar VD/VT, the volume of CO(2) excretion and the slope of the alveolar plateau which reflects ventilation: perfusion heterogeneity. Many of these measurements now can be made non-invasively which should only increase the research and clinical utility of volumetric capnography in studying and managing patients with ALI/ARDS.
Topics: Acute Lung Injury; Humans; Positive-Pressure Respiration; Prone Position; Pulmonary Circulation; Respiratory Dead Space; Respiratory Distress Syndrome; Respiratory Mechanics; Tidal Volume
PubMed: 22858884
DOI: No ID Found -
Anesthesiology Dec 2010
Topics: Acute Lung Injury; Anesthesia; Humans; Lung; Positive-Pressure Respiration; Prone Position; Pulmonary Alveoli; Pulmonary Gas Exchange; Respiratory Distress Syndrome; Supine Position
PubMed: 21042196
DOI: 10.1097/ALN.0b013e3181fcd97e -
Annals of the American Thoracic Society Mar 2021
Topics: Cohort Studies; Extracorporeal Membrane Oxygenation; Humans; Prone Position; Respiratory Distress Syndrome; Retrospective Studies
PubMed: 33646078
DOI: 10.1513/AnnalsATS.202011-1444ED -
Canadian Respiratory Journal 2014The emergence of computed tomography imaging more than 25 years ago led to characterization of acute respiratory distress syndrome (ARDS) as areas of relatively normal... (Review)
Review
The emergence of computed tomography imaging more than 25 years ago led to characterization of acute respiratory distress syndrome (ARDS) as areas of relatively normal lung parenchyma juxtaposed with areas of dense consolidation and atelectasis. Given that this heterogeneity is often dorsally distributed, investigators questioned whether care for ARDS patients in the prone position would lead to improved mortality outcomes. This clinical review discusses the physiological rationale and clinical evidence supporting prone positioning in treating ARDS, in addition to its complications and contraindications.
Topics: Humans; Oxygen; Prone Position; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 24927376
DOI: 10.1155/2014/472136 -
Medicina (Kaunas, Lithuania) Feb 2023: Supracondylar fractures of the humerus (SCHF) make up about one-third of pediatric fractures and are the most common elbow fractures in children. Reduction and... (Review)
Review
: Supracondylar fractures of the humerus (SCHF) make up about one-third of pediatric fractures and are the most common elbow fractures in children. Reduction and fixation of SC fractures can be performed with the patient in the prone or supine position. However, the role of the patient's position during surgery is still unclear. The purpose of this systematic review is to evaluate, based on data from the literature, the role of patient position during closed reduction and fixation of pediatric SCHFs. : A systematic review of the current literature from 1951 to 2021 was conducted according to PRISMA guidelines. Articles were identified from 6 public databases. Articles were screened and abstracted by two investigators and the quality of included publications ( = 14) was assessed (MINORS criteria). Statistical analyses were performed using R studio 4.1.2. : The systematic literature review identified 114 articles, from which, according to inclusion and exclusion criteria, 14 studies were identified. A total of 741 children were treated in the prone position and 538 in the supine position. The results of the systematic review showed that there were no statistical differences between the two positions with regard to clinical, radiographic, and complication outcomes. : The functional and radiographic outcome of displaced SCHFs is generally excellent regardless of the position, prone or supine, in which the patient is positioned for surgery. The choice of how to position the patient depends on the habit and experience of the surgeon and anesthesiologist performing the surgery.
Topics: Child; Humans; Supine Position; Prone Position; Humerus; Humeral Fractures; Fracture Fixation, Internal; Treatment Outcome; Retrospective Studies
PubMed: 36837576
DOI: 10.3390/medicina59020374 -
Minerva Anestesiologica Jul 2021Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. We undertook a meta-analysis of randomized controlled trials (RCTs) to... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. We undertook a meta-analysis of randomized controlled trials (RCTs) to determine the mortality benefit of non-specialist therapeutic interventions for ARDS available to general critical care units.
EVIDENCE ACQUISITION
A systematic search of MEDLINE, Embase, and the Cochrane Central Register for RCTs investigating therapeutic interventions in ARDS including corticosteroids, fluid management strategy, high PEEP, low tidal volume ventilation, neuromuscular blockade, prone position ventilation, or recruitment maneuvers. Data was collected on demographic information, treatment strategy, duration and dose of treatment, and primary (28 or 30-day mortality) and secondary (P
a O2 :FiO2 ratio at 24-48 hours) outcomes.EVIDENCE SYNTHESIS
No improvement in 28-day mortality could be demonstrated in three RCTs investigating high PEEP (28.0% vs. 30.2% control; risk ratio [confidence interval] 0.93 [0.82-1.06]; eight assessing prone position ventilation (39.3% vs. 44.5%; RR 0.83 [0.68-1.01]; seven investigating neuromuscular blockade (37.8% vs. 42.0%; RR 0.91 [0.81-1.03]); ten investigating recruitment maneuvers (42.4% vs. 42.1%; RR 1.01 [0.91-1.12]); eight investigating steroids (34.8% vs. 41.1%; RR 0.81 [0.59-1.12]); and one investigating conservative fluid strategies (25.4% vs. 28.4%; RR 0.90 [0.73-1.10]). Three studies assessing low tidal volume ventilation (33.1% vs. 41.9%; RR 0.79 (0.68-0.91); P=0.001), and subgroup analyses within studies investigating prone position ventilation greater than 12 hours (33.1% vs. 44.4%; RR 0.75 [0.59-0.95), P=0.02) did reveal outcome benefit.
CONCLUSIONS
Among non-specialist therapeutic strategies available to general critical care units, low tidal volumes and prone position ventilation for greater than 12 hours improve mortality in ARDS.
Topics: Humans; Positive-Pressure Respiration; Prone Position; Respiration, Artificial; Respiratory Distress Syndrome; Tidal Volume
PubMed: 33594874
DOI: 10.23736/S0375-9393.21.15254-X -
Medicine Dec 2021This study investigated whether postoperative rotational deformity in adolescent idiopathic scoliosis patients could be predicted by prone-position pre-operative angle...
This study investigated whether postoperative rotational deformity in adolescent idiopathic scoliosis patients could be predicted by prone-position pre-operative angle of trunk rotation (ATR).Surgical rib hump correction is performed with the patient in a prone position. However, the association between pre-operative ATR in the prone position and postoperative ATR results is unknown.Thirty-four consecutive patients who underwent skip pedicle screw fixation for Lenke type 1 or 2 adolescent idiopathic scoliosis were retrospectively reviewed. All subjects were followed for a minimum of 1 year. ATR measurements were taken for the standing-flexion position with a scoliometer before surgery and at 1 year afterward. Pre-operative measurements were also taken for the prone position. Correlations between pre- and postoperative ATR were calculated by means of Pearson correlation coefficient. Associations between the correction angle from the standing-flexion position to prone position and postoperative standing-flexion correction angle were determined by linear regression analysis.Pre- and postoperative ATR for the standing-flexion position showed a moderate association (r = 0.64, P < .01). A similar correlation was seen for pre-operative prone-position ATR and postoperative standing-flexion ATR (r = 0.56, P < .01). In linear regression analysis, there was significant proportional error between the correction angle from the standing-flexion position to prone position and postoperative standing-flexion correction angle (β = 0.40, P < .01).In conclusion, pre-operative ATR in either standing-flexion or prone position and postoperative standing-flexion ATR displayed moderate associations. Linear regression analysis revealed that ATR correction angle could be estimated by calculating the correction gains of 0.4° per 1° of correction angle in the prone position.
Topics: Adolescent; Female; Humans; Kyphosis; Male; Pedicle Screws; Prone Position; Retrospective Studies; Scoliosis; Spinal Fusion; Thoracic Vertebrae; Treatment Outcome
PubMed: 34941198
DOI: 10.1097/MD.0000000000028445 -
Anesthesiology Jun 2023
Topics: Humans; COVID-19; Prone Position; Respiratory Distress Syndrome; Patient Positioning; Respiration, Artificial
PubMed: 36880983
DOI: 10.1097/ALN.0000000000004524 -
BMC Pulmonary Medicine Jul 2023Awake prone positioning (APP) is a recommended therapy for non-intubated ARDS patients, but adherence can be challenging. Understanding the barriers and facilitators of...
BACKGROUND
Awake prone positioning (APP) is a recommended therapy for non-intubated ARDS patients, but adherence can be challenging. Understanding the barriers and facilitators of adherence to APP is essential to increase the adherence of therapy and improve patient outcomes. The objective of this study was to explore the barriers and facilitators of adherence to awake prone ventilation using a qualitative approach and the Capability, Opportunity, Motivation-Behavior (COM-B) model.
METHODS
Semi-structured, in-depth interviews were conducted with patients involved in awake prone ventilation. Data were analyzed using an adapted inductive thematical approach and mapped onto the COM-B model to identify barriers and facilitators to adherence of APP.
RESULTS
Nineteen patients were interviewed (aged 55-92 years). Fifteen themes were identified and mapped directly on to the six COM-B constructs, with "physical challenges" related to physical capability being the primary barrier. These COM-B sub-items reflected five other barriers, including low self-efficacy(M), treatment environment(O), availability of time(O), misconceptions about the treatment(C), and insufficient knowledge(C). Key facilitators in adhering to APP were ability to identify and overcome obstacles(C), availability and affordability of treatment(O), family influences(O), beliefs and trust in treatment(M), fear about the disease(M), and perceived benefits(M). In addition, three factors played the role of both facilitator and barrier, such as media influences(O), healthcare influences(O), and behavioral habits(M).
CONCLUSION
The COM-B model was proved to be a useful framework for identifying the barriers and facilitators of adherence to awake prone ventilation. The findings suggest that adherence behavior is a dynamic and balanced process and interventions aimed at improving adherence to APP should address the barriers related to capability, opportunity, and motivation. Healthcare providers should focus on providing proper guidance and training, creating a comfortable environment, and offering social support to improve patients' capability and opportunity. Additionally, promoting patients' positive beliefs and attitudes towards the treatment and addressing misconceptions and fears can further enhance patients' motivation to adhere to the treatment plan.
Topics: Humans; Wakefulness; Motivation; Prone Position; Qualitative Research; Health Personnel
PubMed: 37468848
DOI: 10.1186/s12890-023-02561-x -
Critical Care (London, England) Nov 2023Prone position has been shown to improve oxygenation and survival in patients with early acute respiratory distress syndrome (ARDS). These beneficial effects are partly... (Observational Study)
Observational Study
Effects of early versus delayed application of prone position on ventilation-perfusion mismatch in patients with acute respiratory distress syndrome: a prospective observational study.
BACKGROUND
Prone position has been shown to improve oxygenation and survival in patients with early acute respiratory distress syndrome (ARDS). These beneficial effects are partly mediated by improved ventilation/perfusion (V/Q) distribution. Few studies have investigated the impact of early versus delayed proning on V/Q distribution in patients with ARDS. The aim of this study was to assess the regional ventilation and perfusion distribution in early versus persistent ARDS after prone position.
METHODS
This is a prospective, observational study from June 30, 2021, to October 1, 2022 at the medical ICU in Zhongda Hospital, Southeast University. Fifty-seven consecutive adult patients with moderate-to-severe ARDS ventilated in supine and prone position. Electrical impedance tomography was used to study V/Q distribution in the supine position and 12 h after a prone session.
RESULTS
Of the 57 patients, 33 were early ARDS (≤ 7 days) and 24 were persistent ARDS (> 7 days). Oxygenation significantly improved after proning in early ARDS (157 [121, 191] vs. 190 [164, 245] mm Hg, p < 0.001), whereas no significant change was found in persistent ARDS patients (168 [136, 232] vs.177 [155, 232] mm Hg, p = 0.10). Compared to supine position, prone reduced V/Q mismatch in early ARDS (28.7 [24.6, 35.4] vs. 22.8 [20.0, 26.8] %, p < 0.001), but increased V/Q mismatch in persistent ARDS (23.8 [19.8, 28.6] vs. 30.3 [24.5, 33.3] %, p = 0.006). In early ARDS, proning significantly reduced shunt in the dorsal region and dead space in the ventral region. In persistent ARDS, proning increased global shunt. A significant correlation was found between duration of ARDS onset to proning and the change in V/Q distribution (r = 0.54, p < 0.001).
CONCLUSIONS
Prone position significantly reduced V/Q mismatch in patients with early ARDS, while it increased V/Q mismatch in persistent ARDS patients. Trial registration ClinicalTrials.gov (NCT05207267, principal investigator Ling Liu, date of registration 2021.08.20).
Topics: Adult; Humans; Lung; Perfusion; Prone Position; Respiration; Respiration, Artificial; Respiratory Distress Syndrome; Prospective Studies
PubMed: 38012731
DOI: 10.1186/s13054-023-04749-3