Han Jinhai, Ma Siqing, Sun Bin, Wang Hao, Sun Xiaolin, Jia Guibin
Department of Intensive Care Unit, Qinghai Provincial People's Hospital, Xining 810007, Qinghai, China. Corresponding author: Ma Siqing, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Feb;33(2):161-164. doi: 10.3760/cma.j.cn121430-20200707-00502.
To investigate the therapeutic effect of different prone position ventilation (PPV) on patients with severe acute respiratory distress syndrome (ARDS) at high altitude.
The severe ARDS patients who met the Berlin standard admitted to the department of intensive care unit (ICU) of Qinghai Provincial People's Hospital from January 2017 to January 2020 were enrolled. The patients with classic PPV treatment (i.e. alternate prone supine position, about 16 hours per day) were included in the discontinuous PPV group; the patients with modified PPV treatment (i.e. alternate left and right prone positions 20 degree angle-30 degree angle, every 4 hours and continuous treatment for 24 hours per day) were included in the continuous PPV group. The oxygenation index (PaO/FiO), mechanics of breathing, ventilator parameters before treatment and 72 hours after treatment, and mechanical ventilation time, the length of ICU stay, and related complications between the two groups were analyzed.
Eighteen cases were treated with continuous PPV and 20 cases were treated with discontinuous PPV. There were no significant differences in gender, age, acute physiology and chronic health evaluation II (APACHE II), PaO/FiO, lung compliance, driving pressure (ΔP) and positive end expiratory pressure (PEEP) before treatment between the two groups. Compared with before treatment, PaO/FiO in discontinuous PPV group and continuous PPV group was increased significantly after 72-hour treatment [mmHg (1 mmHg = 0.133 kPa): 99.7±15.4 vs. 55.5±6.3, 121.8±25.3 vs. 55.1±7.1, both P < 0.05], lung compliance was improved significantly (mL/cmHO: 36.8±2.4 vs. 28.0±2.0, 43.4±6.7 vs. 27.7±2.1, both P < 0.05), and ΔP was decreased significantly [cmHO (1 cmHO = 0.098 kPa): 10.5 (10.0, 12.0) vs. 13.0 (12.3, 14.0), 10.0 (8.0, 12.0) vs. 13.0 (12.0, 14.0), both P < 0.05], PEEP was also decreased [cmHO: 12 (12, 14) vs. 14 (13, 14), 10 (8, 10) vs. 14 (12, 15), both P < 0.05], and the indexes in continuous PPV group were improved more significantly than those in discontinuous PPV group [PaO/FiO (mmHg): 121.8±25.3 vs. 99.7±15.4, lung compliance (mL/cmHO): 43.4±6.7 vs. 36.8±2.4, ΔP (cmHO): 10.0 (8.0, 12.0) vs. 10.5 (10.0, 12.0), PEEP (cmHO): 10 (8, 10) vs. 12 (12, 14), all P < 0.05]. The duration of mechanical ventilation and the length of ICU stay in the continuous PPV group were significantly shorter than those in the intermittent PPV group [days: 6.0 (5.0, 7.3) vs. 8.0 (7.0, 9.0), 9.7±1.5 vs. 12.1±2.2, both P < 0.01]. During the PPV treatment, there were 3 cases of cheek skin damage and 2 cases of ear skin damage in the continuous PPV group, and 3 cases of facial skin damage in the intermittent PPV group. There was no significant difference in the incidence of complications between the two groups (χ = 0.321, P = 0.571). All patients were repaired normally after PPV, without adverse consequences.
Continuous PPV is more effective than discontinuous PPV in the treatment of severe ARDS patients at high altitude, and the related complications are did not increased in prolonged time of PPV.
探讨不同俯卧位通气（PPV）方式对高原地区重症急性呼吸窘迫综合征（ARDS）患者的治疗效果。
选取2017年1月至2020年1月青海省人民医院重症医学科（ICU）收治的符合柏林标准的重症ARDS患者。经典PPV治疗（即俯卧位与仰卧位交替，每天约16小时）的患者纳入间断PPV组；改良PPV治疗（即左右俯卧位交替呈20度角 - 30度角，每4小时一次，每天持续治疗24小时）的患者纳入持续PPV组。分析两组治疗前及治疗72小时后的氧合指数（PaO/FiO）、呼吸力学、呼吸机参数，以及机械通气时间、ICU住院时间和相关并发症。
持续PPV组治疗18例，间断PPV组治疗20例。两组治疗前在性别、年龄、急性生理与慢性健康状况评分II（APACHE II）、PaO/FiO、肺顺应性、驱动压（ΔP）和呼气末正压（PEEP）方面差异无统计学意义。与治疗前比较，间断PPV组和持续PPV组治疗72小时后PaO/FiO均显著升高[mmHg（1 mmHg = 0.133 kPa）：99.7±15.4比55.5±6.3，121.8±25.3比55.1±7.1，均P < 0.05]，肺顺应性显著改善（mL/cmH₂O：36.8±2.4比28.0±2.0，43.4±6.7比27.7±2.1，均P < 0.05），ΔP显著降低[cmH₂O（1 cmH₂O = 0.098 kPa）：10.5（10.0，12.0）比13.0（12.3，14.0），10.0（8.0，12.0）比13.0（12.0，14.0），均P < 0.05]，PEEP也降低[cmH₂O：12（12，14）比14（13，14），10（8，10）比14（12，15），均P < 0.05]，且持续PPV组各指标改善程度优于间断PPV组[PaO/FiO（mmHg）：121.8±25.3比99.7±15.4，肺顺应性（mL/cmH₂O）：43.4±6.7比36.8±2.4，ΔP（cmH₂O）：10.0（8.0，12.0）比10.5（10.0，12.0），PEEP（cmH₂O）：10（8，10）比12（12，14），均P < 0.05]。持续PPV组机械通气时间和ICU住院时间显著短于间断PPV组[天：6.0（5.0，7.3）比8.0（7.0，9.0），9.7±1.5比12.1±2.2，均P < 0.01]。PPV治疗期间，持续PPV组有3例脸颊皮肤损伤、2例耳部皮肤损伤，间断PPV组有3例面部皮肤损伤。两组并发症发生率差异无统计学意义（χ² = 0.321，P = 0.571）。所有患者PPV后均正常修复，无不良后果。
在高原地区重症ARDS患者治疗中，持续PPV比间断PPV更有效，且延长PPV时间未增加相关并发症。
