A Multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome
A Multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome
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DOI：
10.1164/rccm.200503-353oc
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发表时间：
2006-06-01
影响因子：
24.7
通讯作者：
Albert, Richard K.
中科院分区：
文献类型：
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作者：
Mancebo, Jordi;Fernandez, Rafael;Albert, Richard K.
理由：急性呼吸窘迫综合征（ARDS）、急性肺损伤或急性呼吸衰竭患者俯卧位通气约7小时/天并不能降低死亡率。早期和较长时间的俯卧位通气是否有益，目前尚不清楚。方法：136例重症急性呼吸窘迫综合征患者气管插管后48 h内，60例随机选择仰卧位，76例随机选择俯卧位通气。制定了呼吸机设置和脱机指南。俯卧组给予持续俯卧通气治疗20 h/d。结果：仰卧通气患者重症监护病房病死率为58%(35/60)，俯卧通气患者病死率为43% (33/76)（p = 0.12）。后者在纳入时有较高的简化急性生理评分II。多因素分析显示，纳入时简化急性生理评分II（优势比[OR]， 1.07; p < 0.001）、ARDS诊断与纳入之间的间隔天数（OR, 2.83; p < 0.001）和随机选择仰卧位（OR, 2.53; p = 0.03）是死亡率的独立危险因素。总共进行了718次翻身手术，俯卧位平均为17 h/d，平均为10 d。总共报告了28例并发症，大多数是快速可逆的。结论：俯卧位通气是可行的、安全的，早期应用、全天应用可降低重症ARDS患者的死亡率。
Rationale: Ventilation in the prone position for about 7 h/d in patients with acute respiratory distress syndrome (ARDS), acute lung injury, or acute respiratory failure does not decrease mortality. Whether it is beneficial to administer prone ventilation early, and for longer periods of time, is unknown.Methods: We enrolled 136 patients within 48 h of tracheal intubation for severe ARDS, 60 randomized to supine and 76 to prone ventilation. Guidelines were established for ventilator settings and weaning. The prone group was targeted to receive continuous prone ventilation treatment for 20 h/d.Results: The intensive care unit mortality was 58% (35/60) in the patients ventilated supine and 43% (33/76) in the patients ventilated prone (p = 0.12). The latter had a higher simplified acute physiology score II at inclusion. Multivariate analysis showed that simplified acute physiology score II at inclusion (odds ratio [OR], 1.07; p < 0.001), number of days elapsed between ARDS diagnosis and inclusion (OR, 2.83; p < 0.001), and randomization to supine position (OR, 2.53; p = 0.03) were independent risk factors for mortality. A total of 718 turning procedures were done, and prone position was applied for a mean of 17 h/d for a mean of 10 d. A total of 28 complications were reported, and most were rapidly reversible.Conclusion: Prone ventilation is feasible and safe, and may reduce mortality in patients with severe ARDS when it is initiated early and applied for most of the day.