Wang Zhen, Zhou Yuyan, Zhu Min, Wang Faping, Zhou Yubei, Yu He, Luo Fengming
Department of Respiratory Care, Sichuan University West China Hospital, Chengdu, Sichuan, China.
State Key Laboratory of Respiratory Health and Multimorbidity, West China hospital, Sichuan University, Chengdu, China.
Eur J Med Res. 2024 May 3;29(1):267. doi: 10.1186/s40001-024-01868-7.
Pneumocystis pneumonia is an uncommon precipitant of acute respiratory distress syndrome and is associated with high mortality. Prone positioning ventilation has been proven to reduce mortality in patients with moderate-severe acute respiratory distress syndrome. We investigated the effect of prone positioning on oxygenation and mortality in intubated patients with pneumocystis pneumonia comorbid with moderate-severe acute respiratory distress syndrome.
In this single-center, retrospective, observational, cohort study, eligible patients were enrolled at West China Hospital of Sichuan University from January 1, 2017, to December 31, 2021. Data on demographics, clinical features, ventilation parameters, arterial blood gas, and outcomes were collected. Patients were assigned to the prone cohort or supine cohort according to whether they received prone positioning ventilation. The main outcome was 28-day mortality.
A total of 79 patients were included in the study. Sixty-three patients were enrolled in the prone cohort, and 16 patients were enrolled in the supine cohort. The 28-day mortality was 61.9% in the prone cohort and 68.8% in the supine cohort (P = 0.26), and 90-day mortality was 66.7% in the prone cohort and 68.8% in the supine cohort (P = 0.55). Patients in the supine cohort had fewer invasive mechanical ventilation days and more ventilator-free days. The incidence of complications was higher in the prone cohort than in the supine cohort.
In patients with pneumocystis pneumonia and moderate-severe acute respiratory distress syndrome, prone positioning did not decrease 28-day or 90-day mortality. Trial registration ClinicalTrials.gov number, ChiCTR2200063889. Registered on 20 September 2022, https://www.chictr.org.cn/showproj.html?proj=174886 .
肺孢子菌肺炎是急性呼吸窘迫综合征的一种罕见诱因，且与高死亡率相关。俯卧位通气已被证明可降低中重度急性呼吸窘迫综合征患者的死亡率。我们研究了俯卧位对合并中重度急性呼吸窘迫综合征的肺孢子菌肺炎插管患者氧合及死亡率的影响。
在这项单中心、回顾性、观察性队列研究中，符合条件的患者于2017年1月1日至2021年12月31日在四川大学华西医院入组。收集了人口统计学、临床特征、通气参数、动脉血气和结局数据。根据患者是否接受俯卧位通气，将其分为俯卧位组或仰卧位组。主要结局为28天死亡率。
共79例患者纳入研究。俯卧位组63例患者，仰卧位组16例患者。俯卧位组28天死亡率为61.9%，仰卧位组为68.8%（P = 0.26）；俯卧位组90天死亡率为66.7%，仰卧位组为68.8%（P = 0.55）。仰卧位组患者有创机械通气天数较少，无呼吸机天数较多。俯卧位组并发症发生率高于仰卧位组。
在合并中重度急性呼吸窘迫综合征的肺孢子菌肺炎患者中，俯卧位并不能降低28天或90天死亡率。试验注册ClinicalTrials.gov编号，ChiCTR2200063889。于2022年9月20日注册，https://www.chictr.org.cn/showproj.html?proj=174886 。
