Su Longxiang, Zhang Jing, Zhao Hua, Li Zunzhu, Luo Hongbo, Liu Jianzhou, Miao Qi, Deng Haibo, Cui Na, He Huaiwu, Chai Wenzhao, Long Yun
Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Intensive Care Unit, Chongqing General Hospital, Chongqing University, Chongqing, China.
J Thorac Dis. 2024 Aug 31;16(8):4967-4976. doi: 10.21037/jtd-24-323. Epub 2024 Aug 22.
Acute respiratory distress syndrome (ARDS) is a leading cause of postoperative respiratory failure after cardiac surgery, and the mortality rate is extremely high. Although prone positioning (PP) may be safe and effective for ARDS, it is still not widely adopted in cardiac surgery patients. We aimed to assess the efficacy and safety of early PP in ARDS after cardiac surgery.
This is a single-center retrospective cohort study. We included adult intensive care unit (ICU) patients who developed ARDS with arterial pressure of oxygen to fraction of oxygen ratio (P/F) ≤200 mmHg within 72 hours after cardiac surgery between 1 January 2019 and 1 August 2023. The outcomes were P/F after 1 session of PP, duration of mechanical ventilation (MV) and ICU stay, and adverse events.
In total, 79 patients who underwent PP and 87 patients who underwent supine position (SP) were included. The mean time to perform PP after ICU admission was 38.0 hours. The P/F improved significantly after 1 session of PP treatment [160.0 (127.8-184.3) 275.0 (220.0-325.0) mmHg, P<0.001], the duration of MV and ICU stay in the PP group were significantly shorter than those in the SP group [84.0 (64.0-122.0) 120.0 (97.0-182.0) h, P<0.001; 6.0 (5.0-8.0) 8.0 (6.0-12.0) days, P<0.001, respectively]. No adverse events were observed during the PP even in patients with intra-aortic balloon pump (IABP).
Early PP treatment is effective and safe for patients with moderate to severe ARDS after cardiac surgery and it is even safe in a subgroup placed with IABP.
急性呼吸窘迫综合征（ARDS）是心脏手术后术后呼吸衰竭的主要原因，死亡率极高。尽管俯卧位通气（PP）对ARDS可能是安全有效的，但在心脏手术患者中仍未广泛采用。我们旨在评估心脏手术后早期PP治疗ARDS的疗效和安全性。
这是一项单中心回顾性队列研究。我们纳入了2019年1月1日至2023年8月1日期间心脏手术后72小时内发生ARDS且氧合指数（P/F）≤200 mmHg的成人重症监护病房（ICU）患者。观察指标为1次PP治疗后的P/F、机械通气（MV）时间、ICU住院时间及不良事件。
共纳入79例行PP治疗的患者和87例行仰卧位（SP）治疗的患者。ICU入院后进行PP治疗的平均时间为38.0小时。1次PP治疗后P/F显著改善[160.0（127.8 - 184.3）对275.0（220.0 - 325.0）mmHg，P<0.001]，PP组的MV时间和ICU住院时间均显著短于SP组[84.0（64.0 - 122.0）对120.0（97.0 - 182.0）小时，P<0.001；6.0（5.0 - 8.0）对8.0（6.0 - 12.0）天，P<0.001]。即使在使用主动脉内球囊反搏（IABP）的患者中，PP治疗期间也未观察到不良事件。
早期PP治疗对心脏手术后中重度ARDS患者有效且安全，在放置IABP的亚组患者中也是安全的。
