Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome

Taccone, Paolo; Pesenti, Antonio; Latini, Roberto; Polli, Federico; Vagginelli, Federica; Mietto, Cristina; Caspani, Luisa; Raimondi, Ferdinando; Bordone, Giovanni; Iapichino, G.; Mancebo, Jordi; Guérin, Claude; Ayzac, Louis; Blanch, Lluís; Fumagalli, Roberto; Tognoni, Gianni; Gattinoni, Luciano; Group, for the Prone-Supine II Study

doi:10.1001/jama.2009.1614

Cited by 493 publications

(433 citation statements)

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“…In a recent multicentre study [22], ARDS patients with similar baseline SAPS II scores and oxygenation disturbances had similar evolution of their respiratory variables and SOFA scores during early follow-up, and a long-term mortality of 63.2%.…”

Section: Discussionmentioning

confidence: 90%

“…Previous trials evaluated continuous HFO [23,24], prone positioning [22,25,26] and high PEEP with/without RMs [27][28][29]. Positive findings comprised improved oxygenation [22,[24][25][26][27][28][29], improved respiratory mechanics [26,27,29], lower rates of refractory hypoxaemia [28,29], and more ventilatorfree and organ failure-free days [29].…”

Section: Discussionmentioning

confidence: 99%

“…Positive findings comprised improved oxygenation [22,[24][25][26][27][28][29], improved respiratory mechanics [26,27,29], lower rates of refractory hypoxaemia [28,29], and more ventilatorfree and organ failure-free days [29]. However, results on mortality were inconclusive.…”

Section: Discussionmentioning

confidence: 99%

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Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

Mentzelopoulos¹,

Malachias²,

Ζιντζαράς³

et al. 2011

Eur Respir J

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In acute respiratory distress syndrome (ARDS), recruitment sessions of highfrequency oscillation (HFO) and tracheal gas insufflation (TGI) with short-lasting recruitment manoeuvres (RMs) may improve oxygenation and enable reduction of subsequent conventional mechanical ventilation (CMV) pressures. We determined the effect of adding HFO-TGI sessions to lung-protective CMV on early/severe ARDS outcome.We conducted a prospective clinical trial, subdivided into a first single-centre period and a second two-centre period. We enrolled 125 (first period, n554) patients with arterial oxygen tension (Pa,O 2 )/inspiratory oxygen fraction (FI,O 2 ) of ,150 mmHg for .12 consecutive hours at an end-expiratory pressure of o8 cmH 2 O. Patients were randomly assigned to an HFO-TGI group (receiving HFO-TGI sessions with RMs, interspersed with lung-protective CMV; n561) or CMV group (receiving lung-protective CMV and RMs; n564). The primary outcome was survival to hospital discharge.Pre-enrolment ventilation duration was variable. During days 1-10 post-randomisation, Pa,O 2 / FI,O 2 , oxygenation index, plateau pressure and respiratory compliance were improved in the HFO-TGI group versus the CMV group (p,0.001 for group6time). Within days 1-60, the HFO-TGI group had more ventilator-free days versus the CMV group (median (interquartile range) 31.0 (0.0-42.0) versus 0.0 (0.0-23.0) days; p,0.001), and more days without respiratory, circulatory, renal, coagulation and liver failure (pf0.003). Survival to hospital discharge was higher in the HFO-TGI group versus the CMV group (38 (62.3%) out of 61 versus 23 (35.9%) out of 64 subjects; p50.004).Intermittent recruitment with HFO-TGI and RMs may improve survival in early/severe ARDS.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

Mentzelopoulos¹,

Malachias²,

Ζιντζαράς³

et al. 2011

Eur Respir J

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“…Despite what we have learned regarding lung-protective ventilation strategies with low tidal volumes, ARDS still carries a high mortality rate. 9,10 Strategies such as prone positioning [11][12][13][14] and targeting higher than traditional PEEP to achieve an open lung have some limited evidence of therapeutic effectiveness. 15,16 The use of NMBAs early in the development of ARDS has been a strategy of interest for the last decade.…”

Section: Introductionmentioning

confidence: 99%

Early Paralysis for the Management of ARDS

2016

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SummaryThe use of neuromuscular blocking agents (NMBAs) early in the development of ARDS has been a strategy of interest for many years. The use of NMBAs with a concomitant deep sedation strategy can increase oxygenation and possibly decrease mortality when used in the early stages of ARDS. The mechanism by which this occurs is unclear but probably involves a combination of factors, such as improving patient-ventilator synchrony, decreasing oxygen consumption, and decreasing the systemic inflammatory response associated with ARDS. The use of NMBA and deep sedation for these patients is not without consequence. This discussion describes the rationale and evidence behind the use of NMBAs in the setting of ARDS.

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“…At first glance, the just published prospective follow-up RCT of PP conducted in ARDS patients with moderate to severe hypoxemia both disappoints in not showing overall benefit and affirms that potential benefits are most likely to accrue in those most severely affected [12]. The signal, while clearly present, is not overwhelmingly strong and would have required enrolment of many more patients for the trend to reach statistical significance.…”

mentioning

confidence: 98%

Prone positioning for ARDS: defining the target

Marini

2010

Intensive Care Med

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Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome

Cited by 493 publications

References 20 publications

Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

Intermittent recruitment with high-frequency oscillation/tracheal gas insufflation in acute respiratory distress syndrome

Early Paralysis for the Management of ARDS

Prone positioning for ARDS: defining the target

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