Hospital Universitario San Ignacio, Pontificia Universidad Javeriana - Bogotá, Colombia.
Pontificia Universidad Javeriana - Bogotá, Colombia.
Crit Care Sci. 2023 Apr-Jun;35(2):156-162. doi: 10.5935/2965-2774.20230343-en.
To identify risk factors for nonresponse to prone positioning in mechanically ventilated patients with COVID-19-associated severe acute respiratory distress syndrome and refractory hypoxemia in a tertiary care hospital in Colombia.
Observational study based on a retrospective cohort of mechanically ventilated patients with severe acute respiratory distress syndrome due to SARS-CoV-2 who underwent prone positioning due to refractory hypoxemia. The study considered an improvement ≥ 20% in the PaO2/FiO2 ratio after the first cycle of 16 hours in the prone position to be a 'response'. Nonresponding patients were considered cases, and responding patients were controls. We controlled for clinical, laboratory, and radiological variables.
A total of 724 patients were included (58.67 ± 12.37 years, 67.7% males). Of those, 21.9% were nonresponders. Mortality was 54.1% for nonresponders and 31.3% for responders (p < 0.001). Variables associated with nonresponse were time from the start of mechanical ventilation to pronation (OR 1.23; 95%CI 1.10 - 1.41); preintubation PaO2/FiO2 ratio (OR 0.62; 95%CI 0.40 - 0.96); preprone PaO2/FiO2 ratio (OR 1.88. 95%CI 1.22 - 2.94); and radiologic multilobe consolidation (OR 2.12; 95%CI 1.33 - 3.33) or mixed pattern (OR 1.72; 95%CI 1.07 - 2.85) compared with a ground-glass pattern.
This study identified factors associated with nonresponse to prone positioning in patients with refractory hypoxemia and acute respiratory distress syndrome due to SARS-CoV-2 receiving mechanical ventilation. Recognizing such factors helps identify candidates for other rescue strategies, including more extensive prone positioning or extracorporeal membrane oxygenation. Further studies are needed to assess the consistency of these findings in populations with acute respiratory distress syndrome of other etiologies.
在哥伦比亚的一家三级护理医院中，确定 COVID-19 相关严重急性呼吸窘迫综合征和难治性低氧血症机械通气患者对俯卧位治疗无反应的危险因素。
这是一项基于 SARS-CoV-2 导致严重急性呼吸窘迫综合征患者的回顾性队列观察性研究，这些患者因难治性低氧血症而接受俯卧位治疗。该研究将俯卧位第一个 16 小时周期后 PaO2/FiO2 比值提高≥20%定义为“有反应”。无反应的患者被视为病例，有反应的患者被视为对照。我们对临床、实验室和影像学变量进行了控制。
共纳入 724 例患者（58.67±12.37 岁，67.7%为男性）。其中，21.9%为无反应者。无反应者的死亡率为 54.1%，而有反应者的死亡率为 31.3%（p<0.001）。与无反应相关的变量包括从开始机械通气到俯卧位的时间（OR 1.23；95%CI 1.10-1.41）；插管前 PaO2/FiO2 比值（OR 0.62；95%CI 0.40-0.96）；俯卧位前 PaO2/FiO2 比值（OR 1.88；95%CI 1.22-2.94）；以及影像学多肺叶实变（OR 2.12；95%CI 1.33-3.33）或混合模式（OR 1.72；95%CI 1.07-2.85），与磨玻璃样模式相比。
本研究确定了 SARS-CoV-2 导致的机械通气难治性低氧血症和急性呼吸窘迫综合征患者对俯卧位治疗无反应的相关因素。识别这些因素有助于确定其他抢救策略的候选者，包括更广泛的俯卧位或体外膜氧合。需要进一步的研究来评估这些发现在其他病因引起的急性呼吸窘迫综合征人群中的一致性。
