Turning Things Around: The Role of Prone Positioning in the Management of Acute Respiratory Failure After Cardiac Surgery

PTO Before ECMO

“…The beneficial effects of prone positioning include reducing overinflated lung areas and promoting alveolar recruitment, homogenizing the pleural pressure gradient, improving oxygenation, and reducing ventilator-induced lung injury. In the authors' experience, prone positioning can be used safely in patients on ECMO, which is supported by the case series reported by Saha et al 1 Unfortunately, cardiac surgery patients usually are not included in the large ARDS trials, which makes it difficult to extrapolate their results to this specific group of patients. It is reasonable to think that the same positive effects of prone positioning apply and that postoperative patients with acute respiratory failure will benefit from prone positioning.…”

“…The evidence 1,5À7 suggests prone positioning after cardiac surgery is feasible and safe and might be used in acute respiratory failure in this specific group of patients. The case series presented by Saha et al 1 in this edition of the journal is useful, and others should be encouraged to report their experience. Prone positioning (or please turn over) should come before ECMO.…”

“…In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Saha et al report their experience of prone positioning patients with respiratory failure after cardiac surgery. 1 This is a very welcome case series directed to those clinicians who have easy access to extracorporeal techniques and sometimes may err toward using them first rather than choosing proven but less technologic options.…”

Complicaciones respiratorias en el posoperatorio de cirugía cardíaca

“…Indudablemente, el posoperatorio de cirugía cardíaca presenta características particulares por la esternotomía, la pericardiotomía, puentes arteriales o venosos u otros procedimientos. No obstante, desde hace años se vienen publicando series de casos con buenos resultados en SDRA severo ventilados en decúbito prono (14,15) . El beneficio se observa incluso en pacientes obesos (índice de masa corporal [IMC] >30 kg/m 2 ), pero a expensas de mayores lesiones por presión (16) .…”

Prone Position in Treatment of Hypoxemia in Patients Who Underwent Type A Aortic Dissection Surgery

“…During the COVID-19 pandemic, a multi-center retrospective study demonstrated that prone ventilation of non-intubated COVID-19 patients significantly reduced the risk of tracheal intubation and death [Coppo 2020]. Saha and colleagues reported that PP could be considered for the treatment of acute respiratory failure after cardiac surgery to improve short-term respiratory conditions and possibly facilitate extracorporeal membrane oxygenation (ECMO) weaning [Saha 2020]. However, limited data exists on the effect of PP in patients who underwent acute TAAD surgery.…”