Prone position and pressure control inverse ratio ventilation in H1N1 patients with severe acute respiratory distress syndrome

Abstract

Aim:To observe the 28 and 90 days mortality associated with prone position and assist control-pressure control (with inverse ratio) ventilation (ACPC-IRV).Materials and Methods:All patients who were admitted to our medical Intensive Care Unit (ICU) who are positive for H1N1 viral infection with severe acute respiratory distress syndrome (ARDS) and requiring invasive mechanical ventilation in prone position were included in our prospective observational study. Six patients who are positive for H1N1 required invasive ventilation in prone position. These patients were planned to ventilate in prone for 16 h and in supine for 8 h daily until P/F ratio >150 with FiO2 of 0.6 or less and positive end-expiratory pressure <10 cm of H2 O.Results:At admission, among these six patients the mean tidal volume generated was about 376.6 ml which was in the range of 6–8 ml/kg predicted body weight. The mean lung injury score was 3.79, mean PaO2 /FiO2 ratio was 52.66 and mean oxygenation index was 29.83. The mean duration of ventilation was 9.4 days (225.6 h). The ICU length of stay was 11.16 days. There was no mortality at 28 and 90 days.Conclusion:Early prone combined with ACPC-IRV in H1N1 patients having severe ARDS can be used as a rescue therapy and it should be confirmed by large observational studies.

Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series

“…[5] As with other causes of ARDS, management of H1N1 viral infection ARDS is focused on LPV strategies, and PPV is a very safe and effective way of achieving improved oxygenation and preventing VILI. [1232] In recent published trials worldwide on severe H1N1 viral ARDS, only 20%, 45%, 34%, 28%, and 47% of patients were subjected to prone position ventilated before starting ECMO in Australian, French, UK, Italian, and German studies, respectively. [2373133]…”

“…[59] In addition, there is scarcity of literature on the use of prone ventilation in H1N1 ARDS patients. [101112] We studied the effect of prone ventilation in severe ARDS patients admitted with the diagnosis of H1N1 during an epidemic in the winter months of 2014–2015 in a southern state of India.…”

Protective mechanical ventilation in suspected influenza infection

“…Furthermore, divergences in ventilatory parameters are found, and there is no protocol that ensures protective mechanical ventilation to this population. There have been no clinical trials, and the results of case and protocol studies are inconclusive, especially regarding the use of alveolar recruitment maneuvers (ARM) and the adjustment of protective positive end-expiratory pressure (PEEP) 2 , 3 .…”

“…Influenza A virus is an important causative agent of acute respiratory disease 3 , which can result in ARDS and the need for ventilatory support. However, studies confirm that mechanical ventilation can exacerbate preexisting lung damage or even cause pulmonary injury itself 7 .…”

“…Cornejo et al 2 and Venkategowda et al 3 demonstrated that protective mechanical ventilation strategies using low tidal volumes improved outcomes among patients with ARDS after influenza infection. In addition, high levels of PEEP and ARM have been used to improve oxygenation, opening collapsed alveoli, and allowing a more homogenous distribution of ventilation 2 , 9 .…”