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Prone positioning and inhaled nitric oxide: synergistic therapies for acute respiratory distress syndrome.

Identifieur interne : 000531 ( Main/Exploration ); précédent : 000530; suivant : 000532

Prone positioning and inhaled nitric oxide: synergistic therapies for acute respiratory distress syndrome.

Auteurs : J A Johannigman [États-Unis] ; K. Davis ; S L Miller ; R S Campbell ; F A Luchette ; S B Frame ; R D Branson

Source :

RBID : pubmed:11318005

Descripteurs français

English descriptors

Abstract

BACKGROUND

Inhaled nitric oxide (INO) and prone positioning have both been advocated as methods to improve oxygenation in patients with acute respiratory distress syndrome (ARDS). This study was designed to evaluate the relative contributions of INO and prone positioning alone and in combination on gas exchange in trauma patients with ARDS.

METHODS

Sixteen patients meeting the consensus definition of ARDS were studied. Patients received mechanical ventilation in the supine position, mechanical ventilation plus INO at 1 part per million in the supine position, mechanical ventilation in the PP, and mechanical ventilation in the prone positioning plus INO at 1 part per million. A stabilization period of 1 hour was allowed at each condition. After stabilization,hemodynamic and gas exchange variables were measured.

RESULTS

INO and prone positioning both increased PaO2/FIO2 compared with ventilation in the supine position. PaO2/FIO2 increased by 14% during use of INO, and 10 of 16 patients (62%) responded to INO in the supine position. PaO2/FIO2 increased by 33%, and 14 of 16 patients (87.5%) responded to the prone position. The combination of INO and prone positioning resulted in an improvement in PaO2/FIO2 in 15 of 16 patients(94%), with a mean increase in PaO2/FIO2 of 59%. Pulmonary vascular resistance was reduced during use of INO, with a greater reduction in pulmonary vascular resistance seen with INO plus prone positioning (175 +/- 36 dynes x s/cm5 vs. 134 +/- 28 dynes x s/cm5) compared with INO in the supine position (164 +/- 48 dynes x s/cm5 vs.138 +/- 44 dynes x s/cm5). There were no significant hemodynamic effects of INO or prone positioning and no complications were seen during this relative short duration of study.

CONCLUSIONS

INO and prone positioning can contribute to improved oxygenation in patients with ARDS. The two therapies in combination are synergistic and may be important adjuncts to mechanical ventilation in the ARDS patient with refractory hypoxemia.


DOI: 10.1097/00005373-200104000-00001
PubMed: 11318005


Affiliations:


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Le document en format XML

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<term>Aged (MeSH)</term>
<term>Blood Gas Analysis (MeSH)</term>
<term>Bronchodilator Agents (administration & dosage)</term>
<term>Combined Modality Therapy (MeSH)</term>
<term>Female (MeSH)</term>
<term>Hemodynamics (drug effects)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Multiple Trauma (complications)</term>
<term>Nitric Oxide (administration & dosage)</term>
<term>Oxygen (blood)</term>
<term>Positive-Pressure Respiration (methods)</term>
<term>Prone Position (MeSH)</term>
<term>Prospective Studies (MeSH)</term>
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<term>Pulmonary Wedge Pressure (drug effects)</term>
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<term>Respiratory Distress Syndrome, Adult (metabolism)</term>
<term>Respiratory Distress Syndrome, Adult (mortality)</term>
<term>Respiratory Distress Syndrome, Adult (physiopathology)</term>
<term>Respiratory Distress Syndrome, Adult (therapy)</term>
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<term>Survival Analysis (MeSH)</term>
<term>Treatment Outcome (MeSH)</term>
<term>Vascular Resistance (drug effects)</term>
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<term>Administration par inhalation (MeSH)</term>
<term>Adulte (MeSH)</term>
<term>Adulte d'âge moyen (MeSH)</term>
<term>Analyse de survie (MeSH)</term>
<term>Association thérapeutique (MeSH)</term>
<term>Bronchodilatateurs (administration et posologie)</term>
<term>Circulation pulmonaire (effets des médicaments et des substances chimiques)</term>
<term>Décubitus dorsal (MeSH)</term>
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<term>Monoxyde d'azote (administration et posologie)</term>
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<term>Polytraumatisme (complications)</term>
<term>Pression artérielle pulmonaire d'occlusion (effets des médicaments et des substances chimiques)</term>
<term>Résistance vasculaire (effets des médicaments et des substances chimiques)</term>
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<term>Échanges gazeux pulmonaires (effets des médicaments et des substances chimiques)</term>
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<term>Monoxyde d'azote</term>
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<term>Respiratory Distress Syndrome, Adult</term>
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<term>Syndrome de détresse respiratoire de l'adulte</term>
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<term>Adult</term>
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<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
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<term>Survival Analysis</term>
<term>Treatment Outcome</term>
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<term>Administration par inhalation</term>
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Analyse de survie</term>
<term>Association thérapeutique</term>
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<term>Décubitus ventral</term>
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<term>Gazométrie sanguine</term>
<term>Humains</term>
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<front>
<div type="abstract" xml:lang="en">
<p>
<b>BACKGROUND</b>
</p>
<p>Inhaled nitric oxide (INO) and prone positioning have both been advocated as methods to improve oxygenation in patients with acute respiratory distress syndrome (ARDS). This study was designed to evaluate the relative contributions of INO and prone positioning alone and in combination on gas exchange in trauma patients with ARDS.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>METHODS</b>
</p>
<p>Sixteen patients meeting the consensus definition of ARDS were studied. Patients received mechanical ventilation in the supine position, mechanical ventilation plus INO at 1 part per million in the supine position, mechanical ventilation in the PP, and mechanical ventilation in the prone positioning plus INO at 1 part per million. A stabilization period of 1 hour was allowed at each condition. After stabilization,hemodynamic and gas exchange variables were measured.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>INO and prone positioning both increased PaO2/FIO2 compared with ventilation in the supine position. PaO2/FIO2 increased by 14% during use of INO, and 10 of 16 patients (62%) responded to INO in the supine position. PaO2/FIO2 increased by 33%, and 14 of 16 patients (87.5%) responded to the prone position. The combination of INO and prone positioning resulted in an improvement in PaO2/FIO2 in 15 of 16 patients(94%), with a mean increase in PaO2/FIO2 of 59%. Pulmonary vascular resistance was reduced during use of INO, with a greater reduction in pulmonary vascular resistance seen with INO plus prone positioning (175 +/- 36 dynes x s/cm5 vs. 134 +/- 28 dynes x s/cm5) compared with INO in the supine position (164 +/- 48 dynes x s/cm5 vs.138 +/- 44 dynes x s/cm5). There were no significant hemodynamic effects of INO or prone positioning and no complications were seen during this relative short duration of study.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>INO and prone positioning can contribute to improved oxygenation in patients with ARDS. The two therapies in combination are synergistic and may be important adjuncts to mechanical ventilation in the ARDS patient with refractory hypoxemia.</p>
</div>
</front>
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<Day>10</Day>
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<Year>2019</Year>
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<AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Inhaled nitric oxide (INO) and prone positioning have both been advocated as methods to improve oxygenation in patients with acute respiratory distress syndrome (ARDS). This study was designed to evaluate the relative contributions of INO and prone positioning alone and in combination on gas exchange in trauma patients with ARDS.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">Sixteen patients meeting the consensus definition of ARDS were studied. Patients received mechanical ventilation in the supine position, mechanical ventilation plus INO at 1 part per million in the supine position, mechanical ventilation in the PP, and mechanical ventilation in the prone positioning plus INO at 1 part per million. A stabilization period of 1 hour was allowed at each condition. After stabilization,hemodynamic and gas exchange variables were measured.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">INO and prone positioning both increased PaO2/FIO2 compared with ventilation in the supine position. PaO2/FIO2 increased by 14% during use of INO, and 10 of 16 patients (62%) responded to INO in the supine position. PaO2/FIO2 increased by 33%, and 14 of 16 patients (87.5%) responded to the prone position. The combination of INO and prone positioning resulted in an improvement in PaO2/FIO2 in 15 of 16 patients(94%), with a mean increase in PaO2/FIO2 of 59%. Pulmonary vascular resistance was reduced during use of INO, with a greater reduction in pulmonary vascular resistance seen with INO plus prone positioning (175 +/- 36 dynes x s/cm5 vs. 134 +/- 28 dynes x s/cm5) compared with INO in the supine position (164 +/- 48 dynes x s/cm5 vs.138 +/- 44 dynes x s/cm5). There were no significant hemodynamic effects of INO or prone positioning and no complications were seen during this relative short duration of study.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">INO and prone positioning can contribute to improved oxygenation in patients with ARDS. The two therapies in combination are synergistic and may be important adjuncts to mechanical ventilation in the ARDS patient with refractory hypoxemia.</AbstractText>
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