Prone positioning improves oxygenation in post-traumatic lung injury--a prospective randomized trial.
Identifieur interne : 000422 ( Main/Exploration ); précédent : 000421; suivant : 000423Prone positioning improves oxygenation in post-traumatic lung injury--a prospective randomized trial.
Auteurs : Gregor Voggenreiter [Allemagne] ; Michael Aufmkolk ; Raphael J. Stiletto ; Markus G. Baacke ; Christian Waydhas ; Claudia Ose ; Eva Bock ; Leo Gotzen ; Udo Obertacke ; Dieter Nast-KolbSource :
- The Journal of trauma [ 0022-5282 ] ; 2005.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Décubitus dorsal (MeSH), Décubitus ventral (physiologie), Facteurs temps (MeSH), Femelle (MeSH), Humains (MeSH), Mâle (MeSH), Pneumopathie infectieuse (prévention et contrôle), Polytraumatisme (physiopathologie), Polytraumatisme (thérapie), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH), Syndrome de détresse respiratoire de l'adulte (thérapie), Ventilation artificielle (méthodes), Ventilation à pression positive (MeSH), Échanges gazeux pulmonaires (MeSH), Études prospectives (MeSH).
- MESH :
- méthodes : Ventilation artificielle.
- physiologie : Décubitus ventral.
- physiopathologie : Polytraumatisme.
- prévention et contrôle : Pneumopathie infectieuse.
- thérapie : Polytraumatisme, Syndrome de détresse respiratoire de l'adulte.
- Adulte, Adulte d'âge moyen, Décubitus dorsal, Facteurs temps, Femelle, Humains, Mâle, Sujet âgé, Sujet âgé de 80 ans ou plus, Ventilation à pression positive, Échanges gazeux pulmonaires, Études prospectives.
English descriptors
- KwdEn :
- Adult (MeSH), Aged (MeSH), Aged, 80 and over (MeSH), Female (MeSH), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Multiple Trauma (physiopathology), Multiple Trauma (therapy), Pneumonia (prevention & control), Positive-Pressure Respiration (MeSH), Prone Position (physiology), Prospective Studies (MeSH), Pulmonary Gas Exchange (MeSH), Respiration, Artificial (methods), Respiratory Distress Syndrome, Adult (therapy), Supine Position (MeSH), Time Factors (MeSH).
- MESH :
- methods : Respiration, Artificial.
- physiology : Prone Position.
- physiopathology : Multiple Trauma.
- prevention & control : Pneumonia.
- therapy : Multiple Trauma, Respiratory Distress Syndrome, Adult.
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Positive-Pressure Respiration, Prospective Studies, Pulmonary Gas Exchange, Supine Position, Time Factors.
Abstract
BACKGROUND
In a prospective randomized trial the effect of prone positioning on the duration of mechanical ventilation was evaluated in multiple trauma patients and was compared with patients ventilated in supine position.
METHOD
Multiple trauma patients of the intensive care units of two university hospitals were considered eligible if they met the criteria for acute lung injury or the acute respiratory distress syndrome. Patients in the prone group (N = 21) were kept prone for at least eight hours and a maximum of 23 hours per day. Prone positioning was continued until a PaO2:FiO2 ratio of more than 300 was present in prone as well as supine position over a period of 48 hours. Patients in the supine group (N = 19) were positioned according to standard care guidelines.
RESULTS
The duration of ventilatory support did not differ significantly (30 +/- 17 days in the prone group and 33 +/- 23 days in the supine group). Worst case analysis (death and deterioration of gas exchange) displayed ventilatory support for 41 +/- 29 days in the prone group and 61 +/- 35 days in the supine group (p = 0.06). The PaO2:FiO2 ratio increased significantly more in the prone group in the first four days (p = 0.03). The prevalence of Acute Respiratory Distress Syndrome (ARDS) following acute lung injury (p = 0.03) and the prevalence of pneumonia (p = 0.048) were reduced also. One patient in the prone and three patients in the supine group died due to multi organ failure (p = 0.27).
CONCLUSIONS
Intermittent prone positioning was not able to reduce the duration of mechanical ventilation in this limited number of patients. However the oxygenation improved significantly over the first four days of treatment, and the prevalence of ARDS and pneumonia were reduced.
DOI: 10.1097/01.ta.0000179952.95921.49
PubMed: 16294072
Affiliations:
Links toward previous steps (curation, corpus...)
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Stiletto</name></author><author><name sortKey="Baacke, Markus G" sort="Baacke, Markus G" uniqKey="Baacke M" first="Markus G" last="Baacke">Markus G. Baacke</name></author><author><name sortKey="Waydhas, Christian" sort="Waydhas, Christian" uniqKey="Waydhas C" first="Christian" last="Waydhas">Christian Waydhas</name></author><author><name sortKey="Ose, Claudia" sort="Ose, Claudia" uniqKey="Ose C" first="Claudia" last="Ose">Claudia Ose</name></author><author><name sortKey="Bock, Eva" sort="Bock, Eva" uniqKey="Bock E" first="Eva" last="Bock">Eva Bock</name></author><author><name sortKey="Gotzen, Leo" sort="Gotzen, Leo" uniqKey="Gotzen L" first="Leo" last="Gotzen">Leo Gotzen</name></author><author><name sortKey="Obertacke, Udo" sort="Obertacke, Udo" uniqKey="Obertacke U" first="Udo" last="Obertacke">Udo Obertacke</name></author><author><name sortKey="Nast Kolb, Dieter" sort="Nast Kolb, Dieter" uniqKey="Nast Kolb D" first="Dieter" last="Nast-Kolb">Dieter Nast-Kolb</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2005">2005</date><idno type="RBID">pubmed:16294072</idno><idno type="pmid">16294072</idno><idno type="doi">10.1097/01.ta.0000179952.95921.49</idno><idno type="wicri:Area/Main/Corpus">000406</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000406</idno><idno type="wicri:Area/Main/Curation">000406</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000406</idno><idno type="wicri:Area/Main/Exploration">000406</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Prone positioning improves oxygenation in post-traumatic lung injury--a prospective randomized trial.</title><author><name sortKey="Voggenreiter, Gregor" sort="Voggenreiter, Gregor" uniqKey="Voggenreiter G" first="Gregor" last="Voggenreiter">Gregor Voggenreiter</name><affiliation wicri:level="1"><nlm:affiliation>Department of Trauma Surgery, University Hospital Mannheim, 68135 Mannheim, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Trauma Surgery, University Hospital Mannheim, 68135 Mannheim</wicri:regionArea><wicri:noRegion>68135 Mannheim</wicri:noRegion><wicri:noRegion>68135 Mannheim</wicri:noRegion><wicri:noRegion>68135 Mannheim</wicri:noRegion></affiliation></author><author><name sortKey="Aufmkolk, Michael" sort="Aufmkolk, Michael" uniqKey="Aufmkolk M" first="Michael" last="Aufmkolk">Michael Aufmkolk</name></author><author><name sortKey="Stiletto, Raphael J" sort="Stiletto, Raphael J" uniqKey="Stiletto R" first="Raphael J" last="Stiletto">Raphael J. 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(physiologie)</term><term>Facteurs temps (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Mâle (MeSH)</term><term>Pneumopathie infectieuse (prévention et contrôle)</term><term>Polytraumatisme (physiopathologie)</term><term>Polytraumatisme (thérapie)</term><term>Sujet âgé (MeSH)</term><term>Sujet âgé de 80 ans ou plus (MeSH)</term><term>Syndrome de détresse respiratoire de l'adulte (thérapie)</term><term>Ventilation artificielle (méthodes)</term><term>Ventilation à pression positive (MeSH)</term><term>Échanges gazeux pulmonaires (MeSH)</term><term>Études prospectives (MeSH)</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Respiration, Artificial</term></keywords><keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Ventilation artificielle</term></keywords><keywords scheme="MESH" qualifier="physiologie" xml:lang="fr"><term>Décubitus ventral</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Prone Position</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Polytraumatisme</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Multiple Trauma</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Pneumonia</term></keywords><keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Pneumopathie infectieuse</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Multiple Trauma</term><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Polytraumatisme</term><term>Syndrome de détresse respiratoire de l'adulte</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Positive-Pressure Respiration</term><term>Prospective Studies</term><term>Pulmonary Gas Exchange</term><term>Supine Position</term><term>Time Factors</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Décubitus dorsal</term><term>Facteurs temps</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Ventilation à pression positive</term><term>Échanges gazeux pulmonaires</term><term>Études prospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>In a prospective randomized trial the effect of prone positioning on the duration of mechanical ventilation was evaluated in multiple trauma patients and was compared with patients ventilated in supine position.</p></div><div type="abstract" xml:lang="en"><p><b>METHOD</b></p><p>Multiple trauma patients of the intensive care units of two university hospitals were considered eligible if they met the criteria for acute lung injury or the acute respiratory distress syndrome. Patients in the prone group (N = 21) were kept prone for at least eight hours and a maximum of 23 hours per day. Prone positioning was continued until a PaO2:FiO2 ratio of more than 300 was present in prone as well as supine position over a period of 48 hours. Patients in the supine group (N = 19) were positioned according to standard care guidelines.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>The duration of ventilatory support did not differ significantly (30 +/- 17 days in the prone group and 33 +/- 23 days in the supine group). Worst case analysis (death and deterioration of gas exchange) displayed ventilatory support for 41 +/- 29 days in the prone group and 61 +/- 35 days in the supine group (p = 0.06). The PaO2:FiO2 ratio increased significantly more in the prone group in the first four days (p = 0.03). The prevalence of Acute Respiratory Distress Syndrome (ARDS) following acute lung injury (p = 0.03) and the prevalence of pneumonia (p = 0.048) were reduced also. One patient in the prone and three patients in the supine group died due to multi organ failure (p = 0.27).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Intermittent prone positioning was not able to reduce the duration of mechanical ventilation in this limited number of patients. However the oxygenation improved significantly over the first four days of treatment, and the prevalence of ARDS and pneumonia were reduced.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">16294072</PMID><DateCompleted><Year>2005</Year><Month>12</Month><Day>20</Day></DateCompleted><DateRevised><Year>2019</Year><Month>07</Month><Day>11</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0022-5282</ISSN><JournalIssue CitedMedium="Print"><Volume>59</Volume><Issue>2</Issue><PubDate><Year>2005</Year><Month>Aug</Month></PubDate></JournalIssue><Title>The Journal of trauma</Title></Journal><ArticleTitle>Prone positioning improves oxygenation in post-traumatic lung injury--a prospective randomized trial.</ArticleTitle><Pagination><MedlinePgn>333-41; discussion 341-3</MedlinePgn></Pagination><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">In a prospective randomized trial the effect of prone positioning on the duration of mechanical ventilation was evaluated in multiple trauma patients and was compared with patients ventilated in supine position.</AbstractText><AbstractText Label="METHOD" NlmCategory="METHODS">Multiple trauma patients of the intensive care units of two university hospitals were considered eligible if they met the criteria for acute lung injury or the acute respiratory distress syndrome. Patients in the prone group (N = 21) were kept prone for at least eight hours and a maximum of 23 hours per day. Prone positioning was continued until a PaO2:FiO2 ratio of more than 300 was present in prone as well as supine position over a period of 48 hours. Patients in the supine group (N = 19) were positioned according to standard care guidelines.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">The duration of ventilatory support did not differ significantly (30 +/- 17 days in the prone group and 33 +/- 23 days in the supine group). Worst case analysis (death and deterioration of gas exchange) displayed ventilatory support for 41 +/- 29 days in the prone group and 61 +/- 35 days in the supine group (p = 0.06). The PaO2:FiO2 ratio increased significantly more in the prone group in the first four days (p = 0.03). The prevalence of Acute Respiratory Distress Syndrome (ARDS) following acute lung injury (p = 0.03) and the prevalence of pneumonia (p = 0.048) were reduced also. One patient in the prone and three patients in the supine group died due to multi organ failure (p = 0.27).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Intermittent prone positioning was not able to reduce the duration of mechanical ventilation in this limited number of patients. However the oxygenation improved significantly over the first four days of treatment, and the prevalence of ARDS and pneumonia were reduced.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Voggenreiter</LastName><ForeName>Gregor</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Department of Trauma Surgery, University Hospital Mannheim, 68135 Mannheim, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Aufmkolk</LastName><ForeName>Michael</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Stiletto</LastName><ForeName>Raphael J</ForeName><Initials>RJ</Initials></Author><Author ValidYN="Y"><LastName>Baacke</LastName><ForeName>Markus G</ForeName><Initials>MG</Initials></Author><Author ValidYN="Y"><LastName>Waydhas</LastName><ForeName>Christian</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Ose</LastName><ForeName>Claudia</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Bock</LastName><ForeName>Eva</ForeName><Initials>E</Initials></Author><Author ValidYN="Y"><LastName>Gotzen</LastName><ForeName>Leo</ForeName><Initials>L</Initials></Author><Author ValidYN="Y"><LastName>Obertacke</LastName><ForeName>Udo</ForeName><Initials>U</Initials></Author><Author ValidYN="Y"><LastName>Nast-Kolb</LastName><ForeName>Dieter</ForeName><Initials>D</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016448">Multicenter Study</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Trauma</MedlineTA><NlmUniqueID>0376373</NlmUniqueID><ISSNLinking>0022-5282</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009104" MajorTopicYN="N">Multiple Trauma</DescriptorName><QualifierName UI="Q000503" MajorTopicYN="N">physiopathology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011014" MajorTopicYN="N">Pneumonia</DescriptorName><QualifierName UI="Q000517" MajorTopicYN="N">prevention & control</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011175" MajorTopicYN="N">Positive-Pressure Respiration</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016684" MajorTopicYN="Y">Prone Position</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011659" MajorTopicYN="N">Pulmonary Gas Exchange</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012121" MajorTopicYN="N">Respiration, Artificial</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016683" MajorTopicYN="N">Supine Position</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013997" MajorTopicYN="N">Time Factors</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2005</Year><Month>11</Month><Day>19</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2005</Year><Month>12</Month><Day>21</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2005</Year><Month>11</Month><Day>19</Day><Hour>9</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">16294072</ArticleId><ArticleId IdType="pii">00005373-200508000-00010</ArticleId><ArticleId IdType="doi">10.1097/01.ta.0000179952.95921.49</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Allemagne</li></country></list><tree><noCountry><name sortKey="Aufmkolk, Michael" sort="Aufmkolk, Michael" uniqKey="Aufmkolk M" first="Michael" last="Aufmkolk">Michael Aufmkolk</name><name sortKey="Baacke, Markus G" sort="Baacke, Markus G" uniqKey="Baacke M" first="Markus G" last="Baacke">Markus G. Baacke</name><name sortKey="Bock, Eva" sort="Bock, Eva" uniqKey="Bock E" first="Eva" last="Bock">Eva Bock</name><name sortKey="Gotzen, Leo" sort="Gotzen, Leo" uniqKey="Gotzen L" first="Leo" last="Gotzen">Leo Gotzen</name><name sortKey="Nast Kolb, Dieter" sort="Nast Kolb, Dieter" uniqKey="Nast Kolb D" first="Dieter" last="Nast-Kolb">Dieter Nast-Kolb</name><name sortKey="Obertacke, Udo" sort="Obertacke, Udo" uniqKey="Obertacke U" first="Udo" last="Obertacke">Udo Obertacke</name><name sortKey="Ose, Claudia" sort="Ose, Claudia" uniqKey="Ose C" first="Claudia" last="Ose">Claudia Ose</name><name sortKey="Stiletto, Raphael J" sort="Stiletto, Raphael J" uniqKey="Stiletto R" first="Raphael J" last="Stiletto">Raphael J. Stiletto</name><name sortKey="Waydhas, Christian" sort="Waydhas, Christian" uniqKey="Waydhas C" first="Christian" last="Waydhas">Christian Waydhas</name></noCountry><country name="Allemagne"><noRegion><name sortKey="Voggenreiter, Gregor" sort="Voggenreiter, Gregor" uniqKey="Voggenreiter G" first="Gregor" last="Voggenreiter">Gregor Voggenreiter</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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