All authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Crit Care Med. 2020 Dec;48(12):1729-1736. doi: 10.1097/CCM.0000000000004611.
Prone position ventilation improves oxygenation and reduces the mortality of patients with severe acute respiratory distress syndrome. However, there is limited evidence about which patients would gain most survival benefit from prone positioning. Herein, we investigated whether the improvement in oxygenation after prone positioning is associated with survival and aimed to identify patients who will gain most survival benefit from prone positioning in patients with acute respiratory distress syndrome.
A retrospective cohort study.
Medical ICU at a tertiary academic hospital between 2014 and 2020.
Adult patients receiving prone positioning for moderate-to-severe acute respiratory distress syndrome.
None.
The main outcomes were ICU and 28-day mortality. A total of 116 patients receiving prone positioning were included, of whom 45 (38.8%) were ICU survivors. Although there was no difference in PaO2:FIO2 ratio before the first prone session between ICU survivors and nonsurvivors, ICU survivors had a higher PaO2:FIO2 ratio after prone positioning than nonsurvivors, with significant between-group difference (p < 0.001). The area under the receiver operating characteristic curve of the percentage change in the PaO2:FIO2 ratio between the baseline and 8-12 hours after the first prone positioning to predict ICU mortality was 0.87 (95% CI, 0.80-0.94), with an optimal cutoff value of 53.5% (sensitivity, 91.5%; specificity, 73.3%). Prone responders were defined as an increase in PaO2:FIO2 ratio of greater than or equal to 53.5%. In the multivariate Cox regression analysis, prone responders (hazard ratio, 0.11; 95% CI, 0.05-0.25), immunocompromised condition (hazard ratio, 2.15; 95% CI, 1.15-4.03), and Sequential Organ Failure Assessment score (hazard ratio, 1.16; 95% CI, 1.06-1.27) were significantly associated with 28-day mortality.
The PaO2:FIO2 ratio after the first prone positioning differed significantly between ICU survivors and nonsurvivors. The improvement in oxygenation after the first prone positioning was a significant predictor of survival in patients with moderate-to-severe acute respiratory distress syndrome.
俯卧位通气可改善氧合并降低严重急性呼吸窘迫综合征患者的死亡率。然而，关于哪些患者将从俯卧位中获得最大的生存获益，证据有限。在此，我们研究了俯卧位通气后氧合的改善是否与生存相关，并旨在确定急性呼吸窘迫综合征患者中哪些患者将从俯卧位中获得最大的生存获益。
回顾性队列研究。
2014 年至 2020 年期间，三级学术医院的重症监护病房。
接受俯卧位通气治疗的中重度急性呼吸窘迫综合征成人患者。
无。
主要结局为 ICU 死亡率和 28 天死亡率。共纳入 116 例接受俯卧位通气的患者，其中 45 例（38.8%）为 ICU 幸存者。尽管 ICU 幸存者与非幸存者在第一次俯卧位前的 PaO2：FIO2 比值无差异，但 ICU 幸存者的 PaO2：FIO2 比值在俯卧位后高于非幸存者，组间差异有统计学意义（p<0.001）。第一次俯卧位后 8-12 小时内 PaO2：FIO2 比值变化的受试者工作特征曲线下面积预测 ICU 死亡率为 0.87（95%CI，0.80-0.94），最佳截断值为 53.5%（敏感性，91.5%；特异性，73.3%）。俯卧位反应者定义为 PaO2：FIO2 比值增加大于或等于 53.5%。在多变量 Cox 回归分析中，俯卧位反应者（危险比，0.11；95%CI，0.05-0.25）、免疫抑制状态（危险比，2.15；95%CI，1.15-4.03）和序贯器官衰竭评估评分（危险比，1.16；95%CI，1.06-1.27）与 28 天死亡率显著相关。
第一次俯卧位后 ICU 幸存者与非幸存者的 PaO2：FIO2 比值有显著差异。第一次俯卧位后氧合的改善是中重度急性呼吸窘迫综合征患者生存的重要预测因素。
