Prone position in ARDS patients: why, when, how and for whom.
Prone position in ARDS patients: why, when, how and for whom.
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DOI：
10.1007/s00134-020-06306-w
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发表时间：
2020-12
影响因子：
38.9
通讯作者：
Mancebo J
中科院分区：
文献类型：
--
作者：
Guérin C;Albert RK;Beitler J;Gattinoni L;Jaber S;Marini JJ;Munshi L;Papazian L;Pesenti A;Vieillard-Baron A;Mancebo J
在ARDS患者中，从仰卧位到俯卧位的改变产生沿着依赖-非依赖轴的更均匀的气体-组织比分布以及更均匀的肺应力和应变分布。俯卧位的改变通常伴随着动脉血气的显著改善，这主要是由于更好的整体通气/灌注匹配。改善氧合和降低死亡率是ARDS患者实施俯卧位的主要原因。死亡率降低的主要原因是非依赖性肺区域的过度扩张较少，依赖性肺区域的周期性打开和关闭较少。俯卧位的唯一绝对禁忌症是不稳定的脊柱骨折。从仰卧位到俯卧位的转换需要一个由4-5名护理人员组成的熟练团队。最常见的不良事件是压疮和面部水肿。最近，俯卧位的使用已扩展到受COVID-19 ARDS影响的非插管自主呼吸患者。这种干预对结果的影响仍然不确定。本文的在线版本（10.1007/s 00134 -020-06306-w）包含补充材料，可供授权用户使用。
In ARDS patients, the change from supine to prone position generates a more even distribution of the gas–tissue ratios along the dependent–nondependent axis and a more homogeneous distribution of lung stress and strain. The change to prone position is generally accompanied by a marked improvement in arterial blood gases, which is mainly due to a better overall ventilation/perfusion matching. Improvement in oxygenation and reduction in mortality are the main reasons to implement prone position in patients with ARDS. The main reason explaining a decreased mortality is less overdistension in non-dependent lung regions and less cyclical opening and closing in dependent lung regions. The only absolute contraindication for implementing prone position is an unstable spinal fracture. The maneuver to change from supine to prone and vice versa requires a skilled team of 4–5 caregivers. The most frequent adverse events are pressure sores and facial edema. Recently, the use of prone position has been extended to non-intubated spontaneously breathing patients affected with COVID-19 ARDS. The effects of this intervention on outcomes are still uncertain. The online version of this article (10.1007/s00134-020-06306-w) contains supplementary material, which is available to authorized users.
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影响因子：
120.7
作者：
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发表时间：
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