Physiological effects and safety of bed verticalization in patients with acute respiratory distress syndrome.
Autor: | Bouchant L; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France., Godet T; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France. tgodet@chu-clermontferrand.fr.; Department of Healthcare Simulation, Université Clermont Auvergne, Clermont-Ferrand, France. tgodet@chu-clermontferrand.fr., Arpajou G; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France., Aupetitgendre L; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France., Cayot S; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France., Guerin R; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France., Jabaudon M; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France.; Université Clermont Auvergne, iGreD, CNRS, INSERM, Clermont-Ferrand, France., Verlhac C; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France., Blondonnet R; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France.; Université Clermont Auvergne, iGreD, CNRS, INSERM, Clermont-Ferrand, France., Borao L; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France., Pereira B; Direction de la Recherche Clinique et de l'Innovation (DRCI), Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Biostatistics Unit, Clermont-Ferrand, France., Constantin JM; Assistance Publique-Hôpitaux de Paris (AP-HP), Département Anesthésie et Réanimation, Hôpital Pitié-Salpêtrière, DREAM, Sorbonne Université, Paris, France., Bazin JE; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France.; Department of Healthcare Simulation, Université Clermont Auvergne, Clermont-Ferrand, France., Futier E; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France.; Université Clermont Auvergne, iGreD, CNRS, INSERM, Clermont-Ferrand, France., Audard J; Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 1 Place Lucie Et Raymond Aubrac, 63000, Clermont-Ferrand, France. jaudard@chu-clermontferrand.fr.; Université Clermont Auvergne, iGreD, CNRS, INSERM, Clermont-Ferrand, France. jaudard@chu-clermontferrand.fr. |
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Jazyk: | angličtina |
Zdroj: | Critical care (London, England) [Crit Care] 2024 Aug 05; Vol. 28 (1), pp. 262. Date of Electronic Publication: 2024 Aug 05. |
DOI: | 10.1186/s13054-024-05013-y |
Abstrakt: | Background: Trunk inclination in patients with Acute Respiratory Distress Syndrome (ARDS) in the supine position has gained scientific interest due to its effects on respiratory physiology, including mechanics, oxygenation, ventilation distribution, and efficiency. Changing from flat supine to semi-recumbent increases driving pressure due to decreased respiratory system compliance. Positional adjustments also deteriorate ventilatory efficiency for CO Methods: A prospective, pilot physiological study was conducted on early ARDS patients in two ICUs at CHU Clermont-Ferrand, France. The protocol involved 30-min step gradual verticalization from a 30° semi-seated position (baseline) to different levels of inclination (0°, 30°, 60°, and 90°), before returning to the baseline position. Measurements included tidal volume, positive end-expiratory pressure (PEEP), esophageal pressures, and pulmonary artery catheter data. The primary endpoint was the variation in transpulmonary driving pressure through the verticalization procedure. Results: From May 2020 through January 2021, 30 patients were included. Transpulmonary driving pressure increased slightly from baseline (median and interquartile range [IQR], 9 [5-11] cmH Conclusions: Verticalization to 90° is feasible in ARDS patients, improving EELV and oxygenation up to 30°, likely due to alveolar recruitment and blood flow redistribution. However, there is a risk of overdistension and hemodynamic instability beyond 30°, necessitating individualized bed angles based on clinical situations. Trial registration ClinicalTrials.gov registration number NCT04371016 , April 24, 2020. (© 2024. The Author(s).) |
Databáze: | MEDLINE |
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