Prone Teaching and Research Group, ICU Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Respir Care. 2022 Jan;67(1):48-55. doi: 10.4187/respcare.08982. Epub 2021 Nov 23.
Prone positioning is used for patients with ARDS undergoing invasive mechanical ventilation; its effectiveness in nonventilated awake patients is unclear. We aimed to evaluate the effectiveness of the prone maneuver in decreasing the risk of intubation and increasing the odds of favorable events.
We prospectively evaluated 66 subjects with COVID-19-related moderate ARDS who were admitted to the ICU; treated with high-flow nasal cannula, noninvasive ventilation, a reservoir mask, or a nasal cannula; and subjected to awake prone maneuvers from March 1, 2020-August 30, 2020. The following factors were recorded at ICU admission: age, sex, prior illness, simplified acute physiology score 3, body mass index, and changes in gas exchange after and before prone positioning. Subjects were divided into a group of responders and nonresponders according to a 20% increase in the [Formula: see text]/[Formula: see text] ratio before and after the maneuver. The need for intubation within 48 h of the start of the maneuver was also evaluated. We also analyzed the differences in mortality, ICU length of stay, hospital length of stay, and duration of mechanical ventilation. A generalized estimating equation model was applied to preprone and postprone means. To control for confounding factors, multivariate Poisson regression was applied.
Forty-one subjects age 54.1 y ± 12.9 were enrolled. Responders showed increased [Formula: see text] ( < .001), [Formula: see text] ( < .001), and [Formula: see text]/[Formula: see text] ratios ( < .001) with the maneuver and reduced breathing frequency. Responders had shorter lengths of stay in the ICU ( < .001) and hospital ( < .003), lower intubation rates at 48 h ( < .012), fewer days of ventilation ( < .02), and lower mortality ( < .001). Subjects who responded to the maneuver had a 54% reduction in the risk of ventilation and prolonged stay in the ICU.
Among the responders to prone positioning, there were fewer deaths, shorter duration of mechanical ventilation, shorter ICU length of stay, and shorter hospital length of stay.
俯卧位通气常用于接受有创机械通气的急性呼吸窘迫综合征（ARDS）患者；对于未接受通气的清醒患者，其有效性尚不清楚。我们旨在评估俯卧位操作降低插管风险和增加有利事件发生几率的效果。
我们前瞻性评估了 2020 年 3 月 1 日至 2020 年 8 月 30 日期间入住 ICU 的 66 例与 COVID-19 相关的中度 ARDS 患者；这些患者接受高流量鼻导管、无创通气、储氧面罩或鼻导管治疗，且进行了清醒俯卧位操作。在入住 ICU 时记录了以下因素：年龄、性别、既往疾病、简化急性生理学评分 3 分、体重指数以及俯卧位前后的气体交换变化。根据操作前后[Formula: see text]/[Formula: see text]比值增加 20%，将患者分为应答组和无应答组。还评估了操作开始后 48 小时内需要插管的情况。我们还分析了死亡率、ICU 住院时间、住院时间和机械通气时间的差异。应用广义估计方程模型对预俯卧位和后俯卧位的平均值进行分析。为了控制混杂因素，应用了多变量泊松回归。
共纳入 41 名年龄 54.1 岁±12.9 岁的患者。应答者表现出[Formula: see text]增加（ <.001）、[Formula: see text]增加（ <.001）和[Formula: see text]/[Formula: see text]比值增加（ <.001），呼吸频率降低。应答者的 ICU 住院时间（ <.001）和住院时间（ <.003）更短，48 小时插管率更低（ <.012），通气时间更短（ <.02），死亡率更低（ <.001）。对俯卧位操作有反应的患者，通气和 ICU 停留时间延长的风险降低了 54%。
在俯卧位操作的应答者中，死亡率更低，机械通气时间更短，ICU 住院时间更短，住院时间更短。
