Prone position in mechanically ventilated patients with severe acute respiratory failure.
Identifieur interne : 000633 ( Main/Exploration ); précédent : 000632; suivant : 000634Prone position in mechanically ventilated patients with severe acute respiratory failure.
Auteurs : G. Chatte [France] ; J M Sab ; J M Dubois ; M. Sirodot ; P. Gaussorgues ; D. RobertSource :
- American journal of respiratory and critical care medicine [ 1073-449X ] ; 1997.
Descripteurs français
- KwdFr :
- Adolescent (MeSH), Adulte (MeSH), Adulte d'âge moyen (MeSH), Femelle (MeSH), Humains (MeSH), Mâle (MeSH), Posture (MeSH), Sujet âgé (MeSH), Syndrome de détresse respiratoire de l'adulte (thérapie), Ventilation artificielle (MeSH), Ventilation à pression positive (MeSH), Échanges gazeux pulmonaires (MeSH).
- MESH :
English descriptors
- KwdEn :
- Adolescent (MeSH), Adult (MeSH), Aged (MeSH), Female (MeSH), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Outcome Assessment, Health Care (MeSH), Positive-Pressure Respiration (MeSH), Posture (MeSH), Pulmonary Gas Exchange (MeSH), Respiration, Artificial (MeSH), Respiratory Distress Syndrome, Adult (therapy).
- MESH :
Abstract
The purpose of this study was to characterize changes in oxygenation, expressed as PaO2/F(I)O2, when patients with severe acute respiratory failure (PaO2/F(I)O2 < 150), unrelated to left ventricular failure to atelectasis, were turned to and from a supine to prone position at 1- and 4-h intervals. Ventilator settings were unchanged. Thirty-two consecutive patients were studied 1 h before, 1 and 4 h during and 1 h after placing in a prone position with PaO2/F(I)O2 of 103 +/- 28, 158 +/- 62, 159 +/- 59, and 128 +/- 52, respectively (ANOVA, p < 0.001). After 1 h in a prone position, improvement of PaO2/F(I)O2 by 20 mm Hg or more was considered a positive response. Seven patients studied had no response (22%), hereafter referred to as nonresponders, and 25 had a positive response (78%), hereafter referred to as responders. Among the seven nonresponders, two did not tolerate the prone position and were returned supine before the end of the 4-h trial. With the remaining five, PaO2/F(I)O2 evolution was 83 +/- 29, 77 +/- 19, 83 +/- 33, and 81 +/- 47, respectively. For two of the 25 responders, measurements are missing after returning to the supine position. In 10 of the 23 responders (43%) who completed the 4 h prone trial, the PaO2/F(I)O2 returned to its starting value when patients were repositioned supine: 117 +/- 24, 164 +/- 44, 156 +/- 55, and 110 +/- 34, respectively (ANOVA, p < 0.01). In 13 of the 23 (57%) improvement persisted: 105 +/- 27, 187 +/- 58, 189 +/- 49, and 157 +/- 49, respectively (ANOVA, p < 0.001). Repeated improvements after turning to a prone position were frequently observed. Side effects in the 32 patients after a total of 294 periods in a prone position included minor skin injury and edema, two instances of apical atelectasis, one catheter removal, one catheter compression, one extubation, and one transient supraventricular tachycardia.
DOI: 10.1164/ajrccm.155.2.9032181
PubMed: 9032181
Affiliations:
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Chatte</name><affiliation wicri:level="3"><nlm:affiliation>Service de Réanimation Medicale et Assistance Respiratoire, Hopital dela Croix Rousse, Lyon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service de Réanimation Medicale et Assistance Respiratoire, Hopital dela Croix Rousse, Lyon</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="Sab, J M" sort="Sab, J M" uniqKey="Sab J" first="J M" last="Sab">J M Sab</name></author><author><name sortKey="Dubois, J M" sort="Dubois, J M" uniqKey="Dubois J" first="J M" last="Dubois">J M Dubois</name></author><author><name sortKey="Sirodot, M" sort="Sirodot, M" uniqKey="Sirodot M" first="M" last="Sirodot">M. Sirodot</name></author><author><name sortKey="Gaussorgues, P" sort="Gaussorgues, P" uniqKey="Gaussorgues P" first="P" last="Gaussorgues">P. Gaussorgues</name></author><author><name sortKey="Robert, D" sort="Robert, D" uniqKey="Robert D" first="D" last="Robert">D. Robert</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="1997">1997</date><idno type="RBID">pubmed:9032181</idno><idno type="pmid">9032181</idno><idno type="doi">10.1164/ajrccm.155.2.9032181</idno><idno type="wicri:Area/Main/Corpus">000635</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000635</idno><idno type="wicri:Area/Main/Curation">000635</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000635</idno><idno type="wicri:Area/Main/Exploration">000635</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Prone position in mechanically ventilated patients with severe acute respiratory failure.</title><author><name sortKey="Chatte, G" sort="Chatte, G" uniqKey="Chatte G" first="G" last="Chatte">G. Chatte</name><affiliation wicri:level="3"><nlm:affiliation>Service de Réanimation Medicale et Assistance Respiratoire, Hopital dela Croix Rousse, Lyon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service de Réanimation Medicale et Assistance Respiratoire, Hopital dela Croix Rousse, Lyon</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation></author><author><name sortKey="Sab, J M" sort="Sab, J M" uniqKey="Sab J" first="J M" last="Sab">J M Sab</name></author><author><name sortKey="Dubois, J M" sort="Dubois, J M" uniqKey="Dubois J" first="J M" last="Dubois">J M Dubois</name></author><author><name sortKey="Sirodot, M" sort="Sirodot, M" uniqKey="Sirodot M" first="M" last="Sirodot">M. Sirodot</name></author><author><name sortKey="Gaussorgues, P" sort="Gaussorgues, P" uniqKey="Gaussorgues P" first="P" last="Gaussorgues">P. Gaussorgues</name></author><author><name sortKey="Robert, D" sort="Robert, D" uniqKey="Robert D" first="D" last="Robert">D. Robert</name></author></analytic><series><title level="j">American journal of respiratory and critical care medicine</title><idno type="ISSN">1073-449X</idno><imprint><date when="1997" type="published">1997</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent (MeSH)</term><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Outcome Assessment, Health Care (MeSH)</term><term>Positive-Pressure Respiration (MeSH)</term><term>Posture (MeSH)</term><term>Pulmonary Gas Exchange (MeSH)</term><term>Respiration, Artificial (MeSH)</term><term>Respiratory Distress Syndrome, Adult (therapy)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent (MeSH)</term><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Mâle (MeSH)</term><term>Posture (MeSH)</term><term>Sujet âgé (MeSH)</term><term>Syndrome de détresse respiratoire de l'adulte (thérapie)</term><term>Ventilation artificielle (MeSH)</term><term>Ventilation à pression positive (MeSH)</term><term>Échanges gazeux pulmonaires (MeSH)</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Syndrome de détresse respiratoire de l'adulte</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Outcome Assessment, Health Care</term><term>Positive-Pressure Respiration</term><term>Posture</term><term>Pulmonary Gas Exchange</term><term>Respiration, Artificial</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Posture</term><term>Sujet âgé</term><term>Ventilation artificielle</term><term>Ventilation à pression positive</term><term>Échanges gazeux pulmonaires</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The purpose of this study was to characterize changes in oxygenation, expressed as PaO2/F(I)O2, when patients with severe acute respiratory failure (PaO2/F(I)O2 < 150), unrelated to left ventricular failure to atelectasis, were turned to and from a supine to prone position at 1- and 4-h intervals. Ventilator settings were unchanged. Thirty-two consecutive patients were studied 1 h before, 1 and 4 h during and 1 h after placing in a prone position with PaO2/F(I)O2 of 103 +/- 28, 158 +/- 62, 159 +/- 59, and 128 +/- 52, respectively (ANOVA, p < 0.001). After 1 h in a prone position, improvement of PaO2/F(I)O2 by 20 mm Hg or more was considered a positive response. Seven patients studied had no response (22%), hereafter referred to as nonresponders, and 25 had a positive response (78%), hereafter referred to as responders. Among the seven nonresponders, two did not tolerate the prone position and were returned supine before the end of the 4-h trial. With the remaining five, PaO2/F(I)O2 evolution was 83 +/- 29, 77 +/- 19, 83 +/- 33, and 81 +/- 47, respectively. For two of the 25 responders, measurements are missing after returning to the supine position. In 10 of the 23 responders (43%) who completed the 4 h prone trial, the PaO2/F(I)O2 returned to its starting value when patients were repositioned supine: 117 +/- 24, 164 +/- 44, 156 +/- 55, and 110 +/- 34, respectively (ANOVA, p < 0.01). In 13 of the 23 (57%) improvement persisted: 105 +/- 27, 187 +/- 58, 189 +/- 49, and 157 +/- 49, respectively (ANOVA, p < 0.001). Repeated improvements after turning to a prone position were frequently observed. Side effects in the 32 patients after a total of 294 periods in a prone position included minor skin injury and edema, two instances of apical atelectasis, one catheter removal, one catheter compression, one extubation, and one transient supraventricular tachycardia.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">9032181</PMID><DateCompleted><Year>1997</Year><Month>03</Month><Day>11</Day></DateCompleted><DateRevised><Year>2019</Year><Month>12</Month><Day>10</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">1073-449X</ISSN><JournalIssue CitedMedium="Print"><Volume>155</Volume><Issue>2</Issue><PubDate><Year>1997</Year><Month>Feb</Month></PubDate></JournalIssue><Title>American journal of respiratory and critical care medicine</Title></Journal><ArticleTitle>Prone position in mechanically ventilated patients with severe acute respiratory failure.</ArticleTitle><Pagination><MedlinePgn>473-8</MedlinePgn></Pagination><Abstract><AbstractText>The purpose of this study was to characterize changes in oxygenation, expressed as PaO2/F(I)O2, when patients with severe acute respiratory failure (PaO2/F(I)O2 < 150), unrelated to left ventricular failure to atelectasis, were turned to and from a supine to prone position at 1- and 4-h intervals. Ventilator settings were unchanged. Thirty-two consecutive patients were studied 1 h before, 1 and 4 h during and 1 h after placing in a prone position with PaO2/F(I)O2 of 103 +/- 28, 158 +/- 62, 159 +/- 59, and 128 +/- 52, respectively (ANOVA, p < 0.001). After 1 h in a prone position, improvement of PaO2/F(I)O2 by 20 mm Hg or more was considered a positive response. Seven patients studied had no response (22%), hereafter referred to as nonresponders, and 25 had a positive response (78%), hereafter referred to as responders. Among the seven nonresponders, two did not tolerate the prone position and were returned supine before the end of the 4-h trial. With the remaining five, PaO2/F(I)O2 evolution was 83 +/- 29, 77 +/- 19, 83 +/- 33, and 81 +/- 47, respectively. For two of the 25 responders, measurements are missing after returning to the supine position. In 10 of the 23 responders (43%) who completed the 4 h prone trial, the PaO2/F(I)O2 returned to its starting value when patients were repositioned supine: 117 +/- 24, 164 +/- 44, 156 +/- 55, and 110 +/- 34, respectively (ANOVA, p < 0.01). In 13 of the 23 (57%) improvement persisted: 105 +/- 27, 187 +/- 58, 189 +/- 49, and 157 +/- 49, respectively (ANOVA, p < 0.001). Repeated improvements after turning to a prone position were frequently observed. Side effects in the 32 patients after a total of 294 periods in a prone position included minor skin injury and edema, two instances of apical atelectasis, one catheter removal, one catheter compression, one extubation, and one transient supraventricular tachycardia.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Chatte</LastName><ForeName>G</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Service de Réanimation Medicale et Assistance Respiratoire, Hopital dela Croix Rousse, Lyon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sab</LastName><ForeName>J M</ForeName><Initials>JM</Initials></Author><Author ValidYN="Y"><LastName>Dubois</LastName><ForeName>J M</ForeName><Initials>JM</Initials></Author><Author ValidYN="Y"><LastName>Sirodot</LastName><ForeName>M</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Gaussorgues</LastName><ForeName>P</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Robert</LastName><ForeName>D</ForeName><Initials>D</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Am J Respir Crit Care Med</MedlineTA><NlmUniqueID>9421642</NlmUniqueID><ISSNLinking>1073-449X</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</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="D017063" MajorTopicYN="N">Outcome Assessment, Health Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011175" MajorTopicYN="N">Positive-Pressure Respiration</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011187" MajorTopicYN="Y">Posture</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011659" MajorTopicYN="N">Pulmonary Gas Exchange</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012121" MajorTopicYN="Y">Respiration, Artificial</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>1997</Year><Month>2</Month><Day>1</Day></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>1997</Year><Month>2</Month><Day>1</Day><Hour>0</Hour><Minute>1</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>1997</Year><Month>2</Month><Day>1</Day><Hour>0</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">9032181</ArticleId><ArticleId IdType="doi">10.1164/ajrccm.155.2.9032181</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>France</li></country><region><li>Auvergne-Rhône-Alpes</li><li>Rhône-Alpes</li></region><settlement><li>Lyon</li></settlement></list><tree><noCountry><name sortKey="Dubois, J M" sort="Dubois, J M" uniqKey="Dubois J" first="J M" last="Dubois">J M Dubois</name><name sortKey="Gaussorgues, P" sort="Gaussorgues, P" uniqKey="Gaussorgues P" first="P" last="Gaussorgues">P. Gaussorgues</name><name sortKey="Robert, D" sort="Robert, D" uniqKey="Robert D" first="D" last="Robert">D. Robert</name><name sortKey="Sab, J M" sort="Sab, J M" uniqKey="Sab J" first="J M" last="Sab">J M Sab</name><name sortKey="Sirodot, M" sort="Sirodot, M" uniqKey="Sirodot M" first="M" last="Sirodot">M. Sirodot</name></noCountry><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Chatte, G" sort="Chatte, G" uniqKey="Chatte G" first="G" last="Chatte">G. Chatte</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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