Cardiac Surgical Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, #324 Jingwu Road, Jinan,Shandong 250021, China.
Nursing Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, #324 Jingwu Road, Jinan, Shandong 250021, China.
Heart Lung. 2022 Nov-Dec;56:24-28. doi: 10.1016/j.hrtlng.2022.05.010. Epub 2022 May 29.
Hypoxemic respiratory failure is a serious complication that can occur at any stage after cardiac surgery. Prone positioning (PP) is safe and effective for patients receiving invasive ventilation after hypoxemic respiratory failure; however, few related studies have focused on its use with extubated cardiac surgery patients. Researchers recently reported beneficial effects of PP for hypoxemic patients with COVID-19 and those with moderate ARDS (acute respiratory distress syndrome,ARDS). PP may also improve oxygenation in extubated cardiac surgery patients.
In this study, we aimed to assess the safety and effectiveness of PP in extubated cardiac surgery patients to determine whether PP can improve oxygenation and respiratory status or reduce secondary intubation.
We reviewed our institutional database between August 2018 and August 2020 and identified 22 cardiac surgery patients who had undergone PP for hypoxemic respiratory failure after extubation. From the medical and nursing records, we extracted the following data recorded before PP, during PP, and after PP for each patient, arterial blood gas analyses, hemodynamic records, laboratory reports, and respiratory function training records.
Twenty-two extubated patients underwent 74 PP. Each patient underwent a median of 3.5 (2-5) procedures, and the median duration of each PP was 10 h. PP was implemented on the 4.5th postoperative day (median). All patients were discharged from the hospital, and none died. No complications were observed. PP improved the P/F ratio (182.65 ± 60.17, 301.53 ± 61.31, and 246.76 ± 65.68, before PP, during PP, and after PP, respectively, p < 0.001). Additionally, the respiratory rate, Forced Vital Capacity (FVC) and PaCO2 also improved, and hemodynamics showed no significant change.
PP may be effective and safe for treating patients who are extubated following cardiac surgery with hypoxemic respiratory failure. For these patients, PP is associated with oxygenation and respiratory condition improvements and low secondary intubation rates.
低氧性呼吸衰竭是心脏手术后任何阶段都可能发生的严重并发症。俯卧位通气（PP）对低氧性呼吸衰竭后接受有创通气的患者是安全且有效的；然而，很少有相关研究关注其在拔管后的心脏手术患者中的应用。研究人员最近报道了 PP 对 COVID-19 低氧血症患者和中度急性呼吸窘迫综合征（ARDS）患者的有益作用。PP 还可能改善拔管后的心脏手术患者的氧合作用。
本研究旨在评估 PP 在拔管后的心脏手术患者中的安全性和有效性，以确定 PP 是否可以改善氧合和呼吸状况或降低二次插管率。
我们回顾了 2018 年 8 月至 2020 年 8 月期间的机构数据库，并确定了 22 例心脏手术后因低氧血症呼吸衰竭而拔管后接受 PP 的患者。从医疗和护理记录中，我们提取了每位患者在接受 PP 前后的动脉血气分析、血流动力学记录、实验室报告和呼吸功能训练记录。
22 例拔管患者接受了 74 次 PP。每位患者接受了中位数为 3.5（2-5）次的治疗，每次 PP 的中位数时间为 10 小时。PP 在术后第 4.5 天进行（中位数）。所有患者均出院，无死亡病例。未观察到并发症。PP 改善了 PaO2/FiO2 比值（分别为 182.65±60.17、301.53±61.31 和 246.76±65.68，在接受 PP 之前、期间和之后，p<0.001）。此外，呼吸频率、用力肺活量（FVC）和 PaCO2 也得到了改善，而血流动力学无明显变化。
PP 可能对治疗心脏手术后因低氧性呼吸衰竭而拔管的患者有效且安全。对于这些患者，PP 与氧合和呼吸状况的改善以及较低的二次插管率相关。
