Effect of prone positioning on gas exchange according to lung morphology in patients with acute respiratory distress syndrome.
Effect of prone positioning on gas exchange according to lung morphology in patients with acute respiratory distress syndrome.
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DOI：
10.4266/acc.2022.00367
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发表时间：
2022-08
影响因子：
1.8
通讯作者：
Lee, Hong Yeul
中科院分区：
文献类型：
--
作者：
Kim, Na Young;Yoon, Si Mong;Park, Jimyung;Lee, Jinwoo;Lee, Sang-Min;Lee, Hong Yeul
关键词：
根据肺部形态进行俯卧位的临床效果的数据有限。我们的目的是确定俯卧位的气体交换反应是否因肺部形态而异。这项回顾性研究包括患有中度至重度急性呼吸窘迫综合征（ARDS）的成年患者。 ARDS 的肺部形态通过胸部计算机断层扫描进行评估，并分为“弥漫性”或“局灶性”。主要结果是第一次俯卧位后动脉氧分压与吸入氧分数 (PaO2/FiO2) 比率的变化：首先，使用整个队列，其次，使用基线时患有弥漫性 ARDS 的患者亚组与局灶性 ARDS 患者以 2 比 1 匹配。纳入 95 名患者（局灶性 ARDS 组，23 例；弥漫性 ARDS 组，72 例）。在俯卧位之前，局灶性 ARDS 组的氧合情况比弥漫性 ARDS 组差（中位 PaO2/FiO2 比值，79.9 mm Hg [四分位距 (IQR)]，67.7–112.6 vs. 104.0 mm Hg [IQR，77.6–135.7]；P=0.042）。在俯卧位期间，局灶性 ARDS 组的 PaO2/FiO2 比值比弥漫性 ARDS 组有更大的改善（中位数为 55.8 mm Hg [IQR，11.1–109.2] 对比 42.8 mm Hg [IQR，11.6–83.2]）；然而，差异并不显着（P=0.705）。在 PaO2/FiO2 匹配队列中，俯卧位后 PaO2/FiO2 比值变化无显着差异（P=0.904）。在中重度 ARDS 患者中，俯卧位后 PaO2/FiO2 比值的变化并没有根据肺部形态而有所不同。因此，无论 ARDS 肺部形态如何，只要有指征就可以考虑俯卧位。
There are limited data on the clinical effects of prone positioning according to lung morphology. We aimed to determine whether the gas exchange response to prone positioning differs according to lung morphology. This retrospective study included adult patients with moderate-to-severe acute respiratory distress syndrome (ARDS). The lung morphology of ARDS was assessed by chest computed tomography scan and classified as “diffuse” or “focal.” The primary outcome was change in partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio after the first prone positioning session: first, using the entire cohort, and second, using subgroups of patients with diffuse ARDS matched 2 to 1 with patients with focal ARDS at baseline. Ninety-five patients were included (focal ARDS group, 23; diffuse ARDS group, 72). Before prone positioning, the focal ARDS group showed worse oxygenation than the diffuse ARDS group (median PaO2/FiO2 ratio, 79.9 mm Hg [interquartile range (IQR)], 67.7–112.6 vs. 104.0 mm Hg [IQR, 77.6–135.7]; P=0.042). During prone positioning, the focal ARDS group showed a greater improvement in the PaO2/FiO2 ratio than the diffuse ARDS group (median, 55.8 mm Hg [IQR, 11.1–109.2] vs. 42.8 mm Hg [IQR, 11.6–83.2]); however, the difference was not significant (P=0.705). Among the PaO2/FiO2-matched cohort, there was no significant difference in change in PaO2/FiO2 ratio after prone positioning between the groups (P=0.904). In patients with moderate-to-severe ARDS, changes in PaO2/FiO2 ratio after prone positioning did not differ according to lung morphology. Therefore, prone positioning can be considered as soon as indicated, regardless of ARDS lung morphology.
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ARDS患者的放射学模式：分配的呼吸技术，气体交换和肺募养性。
影响因子：
8.1
作者：
Coppola S;Pozzi T;Gurgitano M;Liguori A;Duka E;Bichi F;Ciabattoni A;Chiumello D
通讯作者：
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影响因子：
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作者：
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DOI：
10.1186/cc13896
发表时间：
2014-05-28
期刊：
Critical care (London, England)
影响因子：
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作者：
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影响因子：
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作者：
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DOI：
10.1164/rccm.201806-1094oc
发表时间：
2019-10-15
影响因子：
24.7
作者：
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通讯作者：
Smith, Roger