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首页> 外文期刊>Sao Paulo Medical Journal >Effects of prone position on the oxygenation of patients with acute respiratory distress syndrome
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Effects of prone position on the oxygenation of patients with acute respiratory distress syndrome

机译：俯卧位对急性呼吸窘迫综合征患者氧合的影响

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CONTEXT AND OBJECTIVE: Acute respiratory distress syndrome (ARDS) is characterized by arterial hypoxemia, and prone position (PP) is one possible management strategy. The objective here was to evaluate the effects of PP on oxygenation. DESIGN AND SETTING: Non-randomized, open, prospective, controlled clinical trial, in a surgical intensive care unit at a tertiary university hospital. METHODS: Forty-one ARDS patients underwent PP for three-hour periods. Arterial partial oxygen pressure (PaO2) was measured immediately before changing to PP, after 30, 60, 120 and 180 minutes in PP and 60 minutes after returning to dorsal recumbent position (DP). The paired-t and Dunnett tests were used. RESULTS: A notable clinical improvement in oxygenation (> 15%) was detected in 78.0% of patients. This persisted for 60 minutes after returning to DP in 56% and lasted for 12 and 48 hours in 53.6% and 46.3%, respectively. Maximum improvement was seen after 30 minutes in 12.5% of responding patients and after 180 minutes in 40.6%. No statistically significant associations between PP response and age, gender, weight, PEEP level, tidal volume, respiratory rate, PaO2/FiO2 or duration of mechanical ventilation were detected. One accidental extubation and four cases of deterioration through oxygenation were detected. The 48-hour mortality rate was 17%. CONCLUSIONS: For a significant number of ARDS patients, PP may rapidly enhance arterial oxygenation and its inclusion for management of severe ARDS is justified. However, it is not a cost-free maneuver and caution is needed in deciding on using PP.
机译：背景与目的：急性呼吸窘迫综合征（ARDS）以动脉血氧不足为特征，俯卧位（PP）是一种可能的治疗策略。此处的目的是评估PP对氧合作用的影响。设计与设置：在三级大学医院的外科重症监护室进行的非随机，开放，前瞻性，对照临床试验。方法：41名ARDS患者接受PP治疗三个小时。在即将换成PP之前，在PP中放置30、60、120和180分钟后以及回到背卧位（DP）之后60分钟后，测量动脉分压（PaO2）。使用成对的t和Dunnett检验。结果：在78.0％的患者中，氧合的临床改善显着（> 15％）。在返回DP后，持续56分钟达60分钟，分别在53.6％和46.3％下持续了12和48小时。在12.5％的反应患者中30分钟后和40.6％的患者在180分钟后看到最大的改善。没有检测到PP反应与年龄，性别，体重，PEEP水平，潮气量，呼吸频率，PaO2 / FiO2或机械通气时间之间有统计学意义的关联。检出1例意外拔管和4例因氧合作用而恶化。 48小时死亡率为17％。结论：对于许多ARDS患者，PP可能会迅速增强动脉氧合，因此将其纳入重度ARDS的治疗是合理的。但是，这不是一种免费的操作，在决定使用PP时需要谨慎。

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