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Prone positioning improves oxygenation in adult burn patients with severe acute respiratory distress syndrome.

Identifieur interne : 000277 ( Main/Exploration ); précédent : 000276; suivant : 000278

Prone positioning improves oxygenation in adult burn patients with severe acute respiratory distress syndrome.

Auteurs : Diane F. Hale [États-Unis] ; Jeremy W. Cannon ; Andriy I. Batchinsky ; Leopoldo C. Cancio ; James K. Aden ; Christopher E. White ; Evan M. Renz ; Lorne H. Blackbourne ; Kevin K. Chung

Source :

RBID : pubmed:22695433

Descripteurs français

English descriptors

Abstract

BACKGROUND

Prone positioning (PP) improves oxygenation and may provide a benefit in patients with acute respiratory distress syndrome (ARDS). This approach adds significant challenges to patients in intensive care by limiting access to the endotracheal or tracheostomy tube and vascular access. PP also significantly complicates burn care by making skin protection and wound care more difficult. We hypothesize that PP improves oxygenation and can be performed safely in burn patients with ARDS.

METHODS

PP was implemented in a burn intensive care unit for 18 patients with severe refractory ARDS. The characteristics of these patients were retrospectively reviewed to evaluate the impact of PP on Pao2:FiO2 ratio (PFR) during the first 48 hours of therapy. Each patient was considered his or her own control before initiation of PP, and trends in PFR were evaluated with one-way analysis of variance. Secondary measures of complications and mortality were also evaluated.

RESULTS

Mean PFR before PP was 87 (± 38) with a mean sequential organ failure assessment score of 11 (± 4). PFR improved during 48 hours in 12 of 14 survivors (p < 0.05). Mean PFR was 133 (± 77) immediately after PP, 165 (± 118) at 6 hours, 170 (± 115) at 12 hours, 214 (± 126) at 24 hours, 236 (± 137) at 36 hours, and 210 (± 97) at 48 hours. At each measured time interval except the last, PFR significantly improved. There were no unintended extubations. Facial pressure ulcers developed in four patients (22%). Overall, 14 survived 48 hours (78%), 12 survived 28 days (67%), and six survived to hospital discharge (33%).

CONCLUSIONS

PP improves oxygenation in burn patients with severe ARDS and was safely implemented in a burn intensive care unit. Mortality in this population remains high, warranting investigation into additional complementary rescue therapies.

LEVEL OF EVIDENCE

Therapeutic study, level IV.


DOI: 10.1097/TA.0b013e318247cd4f
PubMed: 22695433


Affiliations:


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Le document en format XML

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<term>Adult (MeSH)</term>
<term>Aged (MeSH)</term>
<term>Blood Gas Analysis (MeSH)</term>
<term>Burn Units (MeSH)</term>
<term>Burns, Inhalation (complications)</term>
<term>Burns, Inhalation (diagnosis)</term>
<term>Burns, Inhalation (therapy)</term>
<term>Cohort Studies (MeSH)</term>
<term>Critical Illness (mortality)</term>
<term>Critical Illness (therapy)</term>
<term>Female (MeSH)</term>
<term>Follow-Up Studies (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Injury Severity Score (MeSH)</term>
<term>Intensive Care Units (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Oximetry (MeSH)</term>
<term>Oxygen (blood)</term>
<term>Oxygen Consumption (physiology)</term>
<term>Patient Positioning (methods)</term>
<term>Positive-Pressure Respiration (methods)</term>
<term>Prone Position (MeSH)</term>
<term>Respiratory Distress Syndrome, Adult (etiology)</term>
<term>Respiratory Distress Syndrome, Adult (mortality)</term>
<term>Respiratory Distress Syndrome, Adult (therapy)</term>
<term>Retrospective Studies (MeSH)</term>
<term>Risk Assessment (MeSH)</term>
<term>Survival Analysis (MeSH)</term>
<term>Treatment Outcome (MeSH)</term>
<term>Young Adult (MeSH)</term>
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<term>Adulte (MeSH)</term>
<term>Adulte d'âge moyen (MeSH)</term>
<term>Analyse de survie (MeSH)</term>
<term>Appréciation des risques (MeSH)</term>
<term>Brûlures par inhalation (complications)</term>
<term>Brûlures par inhalation (diagnostic)</term>
<term>Brûlures par inhalation (thérapie)</term>
<term>Consommation d'oxygène (physiologie)</term>
<term>Décubitus ventral (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Gazométrie sanguine (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Jeune adulte (MeSH)</term>
<term>Maladie grave (mortalité)</term>
<term>Maladie grave (thérapie)</term>
<term>Mâle (MeSH)</term>
<term>Oxygène (sang)</term>
<term>Oxymétrie (MeSH)</term>
<term>Positionnement du patient (méthodes)</term>
<term>Résultat thérapeutique (MeSH)</term>
<term>Score de gravité des lésions traumatiques (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Syndrome de détresse respiratoire de l'adulte (mortalité)</term>
<term>Syndrome de détresse respiratoire de l'adulte (thérapie)</term>
<term>Syndrome de détresse respiratoire de l'adulte (étiologie)</term>
<term>Unités de soins intensifs (MeSH)</term>
<term>Unités de soins intensifs de brûlés (MeSH)</term>
<term>Ventilation à pression positive (méthodes)</term>
<term>Études de cohortes (MeSH)</term>
<term>Études de suivi (MeSH)</term>
<term>Études rétrospectives (MeSH)</term>
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<term>Oxygen</term>
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<term>Burns, Inhalation</term>
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<term>Burns, Inhalation</term>
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<term>Brûlures par inhalation</term>
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<keywords scheme="MESH" qualifier="etiology" xml:lang="en">
<term>Respiratory Distress Syndrome, Adult</term>
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<keywords scheme="MESH" qualifier="methods" xml:lang="en">
<term>Patient Positioning</term>
<term>Positive-Pressure Respiration</term>
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<term>Critical Illness</term>
<term>Respiratory Distress Syndrome, Adult</term>
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<term>Syndrome de détresse respiratoire de l'adulte</term>
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<term>Positionnement du patient</term>
<term>Ventilation à pression positive</term>
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<keywords scheme="MESH" qualifier="physiologie" xml:lang="fr">
<term>Consommation d'oxygène</term>
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<keywords scheme="MESH" qualifier="physiology" xml:lang="en">
<term>Oxygen Consumption</term>
</keywords>
<keywords scheme="MESH" qualifier="sang" xml:lang="fr">
<term>Brûlures par inhalation</term>
<term>Oxygène</term>
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<keywords scheme="MESH" qualifier="therapy" xml:lang="en">
<term>Burns, Inhalation</term>
<term>Critical Illness</term>
<term>Respiratory Distress Syndrome, Adult</term>
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<keywords scheme="MESH" qualifier="thérapie" xml:lang="fr">
<term>Brûlures par inhalation</term>
<term>Maladie grave</term>
<term>Syndrome de détresse respiratoire de l'adulte</term>
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<term>Adult</term>
<term>Aged</term>
<term>Blood Gas Analysis</term>
<term>Burn Units</term>
<term>Cohort Studies</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Injury Severity Score</term>
<term>Intensive Care Units</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Oximetry</term>
<term>Prone Position</term>
<term>Retrospective Studies</term>
<term>Risk Assessment</term>
<term>Survival Analysis</term>
<term>Treatment Outcome</term>
<term>Young Adult</term>
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<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Analyse de survie</term>
<term>Appréciation des risques</term>
<term>Décubitus ventral</term>
<term>Femelle</term>
<term>Gazométrie sanguine</term>
<term>Humains</term>
<term>Jeune adulte</term>
<term>Mâle</term>
<term>Oxymétrie</term>
<term>Résultat thérapeutique</term>
<term>Score de gravité des lésions traumatiques</term>
<term>Sujet âgé</term>
<term>Unités de soins intensifs</term>
<term>Unités de soins intensifs de brûlés</term>
<term>Études de cohortes</term>
<term>Études de suivi</term>
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<front>
<div type="abstract" xml:lang="en">
<p>
<b>BACKGROUND</b>
</p>
<p>Prone positioning (PP) improves oxygenation and may provide a benefit in patients with acute respiratory distress syndrome (ARDS). This approach adds significant challenges to patients in intensive care by limiting access to the endotracheal or tracheostomy tube and vascular access. PP also significantly complicates burn care by making skin protection and wound care more difficult. We hypothesize that PP improves oxygenation and can be performed safely in burn patients with ARDS.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>METHODS</b>
</p>
<p>PP was implemented in a burn intensive care unit for 18 patients with severe refractory ARDS. The characteristics of these patients were retrospectively reviewed to evaluate the impact of PP on Pao2:FiO2 ratio (PFR) during the first 48 hours of therapy. Each patient was considered his or her own control before initiation of PP, and trends in PFR were evaluated with one-way analysis of variance. Secondary measures of complications and mortality were also evaluated.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>Mean PFR before PP was 87 (± 38) with a mean sequential organ failure assessment score of 11 (± 4). PFR improved during 48 hours in 12 of 14 survivors (p < 0.05). Mean PFR was 133 (± 77) immediately after PP, 165 (± 118) at 6 hours, 170 (± 115) at 12 hours, 214 (± 126) at 24 hours, 236 (± 137) at 36 hours, and 210 (± 97) at 48 hours. At each measured time interval except the last, PFR significantly improved. There were no unintended extubations. Facial pressure ulcers developed in four patients (22%). Overall, 14 survived 48 hours (78%), 12 survived 28 days (67%), and six survived to hospital discharge (33%).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>PP improves oxygenation in burn patients with severe ARDS and was safely implemented in a burn intensive care unit. Mortality in this population remains high, warranting investigation into additional complementary rescue therapies.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>LEVEL OF EVIDENCE</b>
</p>
<p>Therapeutic study, level IV.</p>
</div>
</front>
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<Month>11</Month>
<Day>21</Day>
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<AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Prone positioning (PP) improves oxygenation and may provide a benefit in patients with acute respiratory distress syndrome (ARDS). This approach adds significant challenges to patients in intensive care by limiting access to the endotracheal or tracheostomy tube and vascular access. PP also significantly complicates burn care by making skin protection and wound care more difficult. We hypothesize that PP improves oxygenation and can be performed safely in burn patients with ARDS.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">PP was implemented in a burn intensive care unit for 18 patients with severe refractory ARDS. The characteristics of these patients were retrospectively reviewed to evaluate the impact of PP on Pao2:FiO2 ratio (PFR) during the first 48 hours of therapy. Each patient was considered his or her own control before initiation of PP, and trends in PFR were evaluated with one-way analysis of variance. Secondary measures of complications and mortality were also evaluated.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Mean PFR before PP was 87 (± 38) with a mean sequential organ failure assessment score of 11 (± 4). PFR improved during 48 hours in 12 of 14 survivors (p < 0.05). Mean PFR was 133 (± 77) immediately after PP, 165 (± 118) at 6 hours, 170 (± 115) at 12 hours, 214 (± 126) at 24 hours, 236 (± 137) at 36 hours, and 210 (± 97) at 48 hours. At each measured time interval except the last, PFR significantly improved. There were no unintended extubations. Facial pressure ulcers developed in four patients (22%). Overall, 14 survived 48 hours (78%), 12 survived 28 days (67%), and six survived to hospital discharge (33%).</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">PP improves oxygenation in burn patients with severe ARDS and was safely implemented in a burn intensive care unit. Mortality in this population remains high, warranting investigation into additional complementary rescue therapies.</AbstractText>
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<CopyrightInformation>Copyright © 2012 by Lippincott Williams & Wilkins.</CopyrightInformation>
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<ForeName>Diane F</ForeName>
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<DescriptorName UI="D010100" MajorTopicYN="N">Oxygen</DescriptorName>
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