Lalwani Lokesh K, Sharma Vinod, Chaudhry Dhruva, Singh Pawan K
Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Indian J Crit Care Med. 2020 Jul;24(7):589-591. doi: 10.5005/jp-journals-10071-23480.
Previously prone positioning (PP) was described in addition to invasive mechanical ventilation and it has been known to reduced mortality and improve oxygenation in patients of ARDS. Recently novel timing of prone positioning was described with the use of high-frequency nasal cannula (HFNC) and noninvasive ventilation (NIV) in patients of acute respiratory distress syndrome (ARDS) to avoid the intubation. Here we would like to share a case of severe ARDS where prone positioning was used in a step further ahead.
A 38-year-old gentleman presented with the complaints of progressive breathlessness, dry cough and fever for 7 days. Patient was diagnosed as a case of H1N1 pneumonia with severe ARDS. Patient was initially managed with invasive mechanical ventilation according to ARDS-Net protocol. Despite persistent hypoxia he was put on prone positioning for consecutive 4 days. Patient was extubated after 10 days of mechanical ventilation and put on HFNC in view of persistent high oxygen requirement. At this point of time, we attempted prone positioning in addition to HFNC. Patient was comfortable on prone position and put himself in the same condition for prolonged periods. His oxygenation showed a remarkable improvement from PaO of 63 (before prone positioning) to 136 mm Hg (after prone positioning). Oxygen supplementation was later tapered off and subsequently, he improved and was shifted to ward.
Prone positioning is a harmless and still extremely effective intervention which can and should be utilized at all steps of ARDS-management.
Lalwani LK, Sharma V, Chaudhry D, Singh PK. Indications for Proning in Acute Respiratory Distress Syndrome: Expanding the Horizon! Indian J Crit Care Med 2020;24(7):589-591.
以前除了有创机械通气外还描述了俯卧位通气，并且已知其可降低急性呼吸窘迫综合征（ARDS）患者的死亡率并改善氧合。最近描述了在急性呼吸窘迫综合征（ARDS）患者中使用高频鼻导管（HFNC）和无创通气（NIV）时俯卧位通气的新时机，以避免插管。在此，我们想分享一例严重ARDS患者，其俯卧位通气的应用更进一步。
一名38岁男性因进行性呼吸困难、干咳和发热7天就诊。患者被诊断为H1N1肺炎合并严重ARDS。患者最初根据ARDS网络协议接受有创机械通气治疗。尽管持续存在低氧血症，但仍连续4天采用俯卧位通气。机械通气10天后患者拔管，鉴于持续高氧需求给予HFNC。此时，除了HFNC外，我们尝试了俯卧位通气。患者在俯卧位时感觉舒适，并长时间保持该姿势。其氧合情况有显著改善，动脉血氧分压（PaO）从俯卧位前的63 mmHg升至俯卧位后的136 mmHg。随后逐渐减少氧疗，患者病情好转并转入病房。
俯卧位通气是一种无害且仍然极其有效的干预措施，在ARDS管理的各个阶段都可以且应该使用。
拉尔瓦尼LK，夏尔马V，乔杜里D，辛格PK。急性呼吸窘迫综合征俯卧位通气的指征：拓展视野！《印度重症监护医学杂志》2020年；24(7):589 - 591。
