Oregon Health and Science University, Portland, Oregon, United States of America.
Froedtert Hospital, Milwaukee, Wisconsin, United States of America.
Nutr Clin Pract. 2021 Feb;36(1):105-109. doi: 10.1002/ncp.10592. Epub 2020 Oct 23.
Acute respiratory distress syndrome (ARDS) is a complex disease characterized by inflammation, resulting in diffuse alveolar damage, proliferation, and fibrosis, and carries a high mortality rate. Recently, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has overwhelmed healthcare systems worldwide, as many patients have required hospitalization for the management of respiratory failure similar in nature to ARDS. In addition to lung-protective ventilation strategies aimed to maintain an oxygen saturation >90%, a ratio of partial pressure of oxygen to fraction of inspired oxygen >200, a pH of 7.25-7.40, and a plateau pressure <35 cm H O, prone positioning has emerged as an effective treatment strategy for severe ARDS by improving oxygenation and secretion clearance. Although early nutrition assessment and intervention are recommended for acutely and critically ill patients, rotational therapy may present challenges in providing this care. Here, we will describe the pathophysiology of ARDS and the rationale for use of prone positioning and review the considerations and challenges of providing nutrition therapy for patients in the prone position.
急性呼吸窘迫综合征（ARDS）是一种复杂的疾病，其特征为炎症导致弥漫性肺泡损伤、增殖和纤维化，且死亡率较高。最近，新型冠状病毒，即严重急性呼吸综合征冠状病毒 2（SARS-CoV-2），使全球的医疗系统不堪重负，因为许多患者需要住院治疗，其呼吸衰竭的性质与 ARDS 相似。除了旨在维持血氧饱和度>90%、氧分压与吸入氧分数比值>200、pH 值为 7.25-7.40 和平台压<35 cmH2O 的肺保护性通气策略外，俯卧位也已成为严重 ARDS 的有效治疗策略，通过改善氧合和分泌物清除。尽管建议对急性和危重症患者进行早期营养评估和干预，但旋转治疗可能会在提供此类护理方面带来挑战。在这里，我们将描述 ARDS 的病理生理学，俯卧位的使用原理，并综述为俯卧位患者提供营养治疗的注意事项和挑战。
