Prone Positioning in Cardiac Surgery: For Many, But Not for Everyone

Autor: A. Junger, Giuseppe Santarpino, C Lim, Martin Wenzl, AM Dell´Aquila, Theodor Fischlein
Rok vydání: 2016
Předmět:
Male
ARDS
Time Factors
Multivariate analysis
030204 cardiovascular system & hematology
Critical Care and Intensive Care Medicine
0302 clinical medicine
Risk Factors
Germany
Odds Ratio
Hospital Mortality
Hypoxia
Aged
80 and over
Respiratory Distress Syndrome
General Medicine
Middle Aged
Cardiac surgery
Prone position
Treatment Outcome
medicine.anatomical_structure
Breathing
Cardiology
Female
Respiratory Insufficiency
Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Lung injury
Patient Positioning
03 medical and health sciences
White blood cell
Internal medicine
mental disorders
Prone Position
medicine
Humans
In patient
Cardiac Surgical Procedures
Intensive care medicine
Aged
Retrospective Studies
business.industry
Patient Selection
Odds ratio
medicine.disease
Surgery
Logistic Models
030228 respiratory system
Multivariate Analysis
Poster Presentation
business
Zdroj: Intensive Care Medicine Experimental
ISSN: 1043-0679
DOI: 10.1053/j.semtcvs.2016.04.008
Popis: Prone positioning is a therapeutic maneuver to improve arterial oxygenation in patients with acute lung injury that is not implemented in most centers performing adult cardiac surgery. The aim of this study was to review our experience with prone positioning to assess the effects of this maneuver in patients with postoperative acute respiratory failure. From 2010-2014, 127 adult patients with postoperative acute respiratory failure were treated with prone positioning in addition to specific therapy. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors associated with in-hospital mortality. In-hospital mortality was 22.8% (n = 29). No significant differences were observed in preoperative risk factors between patients who survived (S) and those who died (D), except for age (62.7 ± 11.2 vs 70.2 ± 11.3; P = 0.007-at multivariate analysis P = 0.03, odds ratio [OR] = 1.1/year). Preproning values of PaO2/FiO2 were significantly different between groups (D vs S: 115 ± 46 vs 150 ± 56; P = 0.006), but only preproning FiO2 remained highly significant at multivariate analysis (D vs S: 0.82 ± 0.18 vs 0.67 ± 0.16; P = 0.001, OR = 1.07; with FiO2 > 0.75 vs < 75, OR = 19.6). D showed a higher improvement of PaO2/FiO2 immediately after prone positioning (207 ± 100 vs 219 ± 90, P = 0.56; within-group analysis between preproning and 1 hour after proning: S-P = 0.49, D-P = 0.019; at 12 hours: 286 ± 123 vs 240 ± 120, P = 0.06; within-group analysis between 1 hour and 12 hours after proning: S-P = 0.15; D-P = 0.17; between groups-P = 0.05). D had higher peak WBC count (26 ± 9.8 vs 17.7 ± 5.9×103/mL; P = 0.0001) and a higher rate of low output syndrome (15 vs 9 patients-51.7% vs 9.2%; P = 0.0001). At multivariate analysis, white blood cell count: P = 0.005, OR = 1.11/103 white blood cell; low output syndrome: P = 0.0002, OR = 20.5. In conclusion, our results show that prone positioning, if performed early, is a safe and effective adjunct measure for patients with postoperative acute hypoxemic respiratory failure of noncardiogenic origin.
Databáze: OpenAIRE
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