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Prone positioning and acute respiratory distress syndrome after cardiac surgery: a feasibility study.

Abstract：

OBJECTIVE:To determine the feasibility, safety, and efficacy on PaO(2)/F(I)O(2) ratio of prone positioning (PP) for acute respiratory distress syndrome (ARDS) after cardiac surgery. DESIGN:Retrospective review of information entered prospectively in the authors' database. SETTING:A private community nonteaching hospital. PARTICIPANTS:Sixteen patients who developed ARDS after cardiac surgery from January 2004 through June 2005. INTERVENTIONS:PP to improve oxygenation. MEASUREMENTS AND MAIN RESULTS:After a median duration of 18 (range, 14-27) hours in PP, PaO(2)/F(I)O(2) improved in 14 (87.5%) patients. For the entire population, median PaO(2)/F(I)O(2) rose from 87 (range, 56-161) before PP to 194 (range, 94-460; p < 0.05) after it. After supine repositioning (SR), PaO(2)/F(I)O(2) declined to 146 (range, 72-320; not significant). PaO(2)/F(I)O(2) at the end of PP and 1 day after SR were comparable, respectively, 194 (range, 94-460) and 184 (range, 105-342). No severe complication was associated with PP, but 5 patients developed pressure sores and 2 others had superficial sternal wound infections. Intensive care unit mortality of 37.5% reflected the number of organ failure(s); there were no deaths with 2 failures, and 60% with > or = 3 organ failures died (p = 0.03). Mortality rates were comparable regardless of whether patients were PaO(2)/F(I)O(2) responders or their PaCO(2) decreased by > or = 1 mmHg. CONCLUSION:PP to treat ARDS after cardiac surgery is feasible, safe, and can efficiently improve oxygenation. Measures to prevent pressure sores are mandatory.

journal_name

J Cardiothorac Vasc Anesth

journal_title

Journal of cardiothoracic and vascular anesthesia

authors

Maillet JM,Thierry S,Brodaty D

doi

10.1053/j.jvca.2007.10.013

subject

Has Abstract

pub_date

2008-06-01 00:00:00

pages

414-7

issue

3

eissn

1053-0770

issn

1532-8422

pii

S1053-0770(07)00323-0

journal_volume

22

pub_type

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