Sella Nicolò, Pettenuzzo Tommaso, Congedi Sabrina, Bisi Maria, Gianino Giulio, De Carolis Agnese, Bertoncello Carlo Alberto, Roccaforte Mario, Zarantonello Francesco, Persona Paolo, Petranzan Enrico, Roca Gabriella, Biamonte Eugenio, Carron Michele, Dell'Amore Andrea, Rea Federico, Boscolo Annalisa, Navalesi Paolo
Anesthesia and Intensive Care, University Hospital of Padua, Padua, Italy.
Department of Medicine, University of Padua, Padua, Italy.
J Cardiothorac Vasc Anesth. 2025 Feb;39(2):479-488. doi: 10.1053/j.jvca.2024.11.018. Epub 2024 Nov 26.
Primary graft dysfunction (PGD) affects survival after lung transplant (LT). The current hypothesis was that prone positioning (PP), proposed as a rescue maneuver to treat refractory hypoxemia due to PGD, may improve LT outcomes, especially when applied early.
Bilateral LT recipients developing moderate-to-severe PGD within 24 hours from intensive care unit admission were enrolled. From January 2020 to November 2021, patients developing PGD after LT were turned prone between 24 and 48 hours after diagnosis, only in case of radiological or oxygenation worsening ("late PP" group). After November 2021, patients were routinely turned prone within 24 hours from PGD diagnosis ("early PP"). A propensity score-weighted analysis, adjusted for clinically relevant covariates, was applied.
Intensive care unit.
Bilateral LT recipients.
Early PP, late PP, or supine position.
130 LT patients were screened and 67 were enrolled. A total of 25 (37%) recipients were treated in the supine position, 24 (36%) in early PP, and 18 (27%) in late PP. After propensity score weighting, both supine treatment (estimated effect for 1 ventilator-free day = 8.23, standard error: 2.97, p = 0.007) and early PP treatment (estimated effect = 9.42, standard error: 2.59, p < 0.001) were associated with greater 28-day ventilator-free days than late PP treatment (reference). Compared with late PP, early PP was also associated with better oxygenation, driving pressure, and static respiratory system compliance. Compared with supine recipients, the early PP group showed better oxygenation at 72 hours after PGD diagnosis.
Early PP in LT recipients with moderate-to-severe PGD seems to be associated with better 28-day ventilator-free days, oxygenation, and driving pressure than late PP.
原发性移植肺功能障碍（PGD）影响肺移植（LT）后的生存率。目前的假设是，俯卧位（PP）作为一种治疗PGD所致难治性低氧血症的挽救措施，可能会改善LT结局，尤其是早期应用时。
纳入在重症监护病房入院后24小时内发生中重度PGD的双侧LT受者。从2020年1月至2021年11月，LT术后发生PGD的患者仅在影像学或氧合恶化时（“晚期PP”组），于诊断后24至48小时转为俯卧位。2021年11月之后，患者在PGD诊断后24小时内常规转为俯卧位（“早期PP”）。应用倾向评分加权分析，并对临床相关协变量进行校正。
重症监护病房。
双侧LT受者。
早期PP、晚期PP或仰卧位。
筛查了130例LT患者，67例被纳入研究。共有25例（37%）受者接受仰卧位治疗，24例（36%）接受早期PP治疗，18例（27%）接受晚期PP治疗。倾向评分加权后，仰卧位治疗（估计无呼吸机天数的效应值=8.23，标准误：2.97，p=0.007）和早期PP治疗（估计效应值=9.42，标准误：2.59，p<0.001）与28天无呼吸机天数均高于晚期PP治疗（参照组）相关。与晚期PP相比，早期PP还与更好的氧合、驱动压和静态呼吸系统顺应性相关。与仰卧位受者相比，早期PP组在PGD诊断后72小时氧合更好。
中重度PGD的LT受者早期PP似乎比晚期PP与更好的28天无呼吸机天数、氧合和驱动压相关。
