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蛛网膜下腔出血所致呼吸功能障碍患者的清醒俯卧位:一例报告

Awake prone positioning in a patient with respiratory impairment due to subarachnoid hemorrhage: a case report.

作者信息

Pacchiarini Giorgia, Geraldini Federico, De Cassai Alessandro, Aviani Fulvio Giulia, Boscolo Annalisa, Zarantonello Francesco, Navalesi Paolo, Munari Marina

机构信息

Department of Medicine, University of Padua, Padua, Italy.

Sant'Antonio Anesthesia and Intensive Care Unit, University-Hospital of Padua, Padua, Italy.

出版信息

J Med Case Rep. 2025 May 28;19(1):255. doi: 10.1186/s13256-025-05311-1.

DOI:10.1186/s13256-025-05311-1
PMID:40437593
Abstract

BACKGROUND

Prone positioning has been shown to be an effective rescue strategy in severe acute respiratory distress syndrome and was widely used during the coronavirus disease 2019 pandemic, both in mechanically ventilated and in awake patients. Subarachnoid hemorrhage is often associated with respiratory failure. Prone positioning has been used in brain-injured patients, but concerns relating to neurological complications from intracranial hypertension still remain.

CASE PRESENTATION

We report the case of a 59-year-old Italian patient with subarachnoid hemorrhage who safely underwent awake prone positioning after deterioration of respiratory function.

CONCLUSIONS

In this report, we show that awake pronation is possible in patients with subarachnoid hemorrhage. However, careful monitoring of Intracranial pressure and clinical examination may be the keys to successful application of this procedure.

摘要

背景

俯卧位通气已被证明是治疗严重急性呼吸窘迫综合征的一种有效挽救策略,并在2019冠状病毒病大流行期间被广泛应用于机械通气患者和清醒患者。蛛网膜下腔出血常伴有呼吸衰竭。俯卧位通气已应用于脑损伤患者,但颅内高压引起神经并发症的担忧仍然存在。

病例报告

我们报告一例59岁意大利蛛网膜下腔出血患者,其在呼吸功能恶化后安全地接受了清醒俯卧位通气。

结论

在本报告中,我们表明蛛网膜下腔出血患者可以进行清醒俯卧位通气。然而,仔细监测颅内压和临床检查可能是成功应用该操作的关键。

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本文引用的文献

1
Feasibility of Prone Positioning for Brain-injured Patients with Severe Acute Respiratory Distress Syndrome: A Systematic Review and Pilot Study (ProBrain).严重急性呼吸窘迫综合征合并脑损伤患者俯卧位通气的可行性:系统评价和初步研究(ProBrain)。
Anesthesiology. 2024 Mar 1;140(3):495-512. doi: 10.1097/ALN.0000000000004875.
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Prone position in mechanically ventilated patients.机械通气患者的俯卧位
Intensive Care Med. 2022 Aug;48(8):1062-1065. doi: 10.1007/s00134-022-06731-z. Epub 2022 Jun 2.
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Acute Respiratory Distress Syndrome in Patients with Subarachnoid Hemorrhage: Incidence, Predictive Factors, and Impact on Mortality.
蛛网膜下腔出血患者的急性呼吸窘迫综合征:发生率、预测因素及其对死亡率的影响。
Interv Neuroradiol. 2023 Apr;29(2):189-195. doi: 10.1177/15910199221082457. Epub 2022 Mar 2.
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Management of intracranial hypertension following traumatic brain injury: a best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy. Joint statements by the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch) and the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI).颅脑创伤后颅内高压的管理:颅内压监测和去骨瓣减压术的最佳临床实践采用建议。意大利神经外科学会(SINch)颅脑创伤分会和意大利麻醉、镇痛、复苏和重症监护学会(SIAARTI)神经麻醉与神经重症监护研究组联合声明。
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Effect of prone versus supine position in COVID-19 patients: A systematic review and meta-analysis.COVID-19 患者俯卧位与仰卧位的效果:系统评价和荟萃分析。
J Clin Anesth. 2021 Nov;74:110406. doi: 10.1016/j.jclinane.2021.110406. Epub 2021 Jun 22.
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Prone Position Ventilation in Neurologically Ill Patients: A Systematic Review and Proposed Protocol.神经疾病患者俯卧位通气:系统评价与方案建议。
Crit Care Med. 2021 Mar 1;49(3):e269-e278. doi: 10.1097/CCM.0000000000004820.
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Acute Distress Respiratory Syndrome After Subarachnoid Hemorrhage: Incidence and Impact on the Outcome in a Large Multicenter, Retrospective Cohort.蛛网膜下腔出血后急性呼吸窘迫综合征:大型多中心回顾性队列研究中的发生率及其对结局的影响。
Neurocrit Care. 2021 Jun;34(3):1000-1008. doi: 10.1007/s12028-020-01115-x. Epub 2020 Oct 20.
8
Awake pronation with helmet continuous positive airway pressure for COVID-19 acute respiratory distress syndrome patients outside the ICU: A case series.针对重症监护病房外的新型冠状病毒肺炎急性呼吸窘迫综合征患者,采用头盔持续气道正压通气进行清醒俯卧位通气:病例系列报告
Med Intensiva (Engl Ed). 2020 Sep 6;46(2):65-71. doi: 10.1016/j.medin.2020.08.008.
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Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study.COVID-19 所致急性呼吸衰竭未插管患者俯卧位通气的可行性和生理影响(PRON-COVID):一项前瞻性队列研究。
Lancet Respir Med. 2020 Aug;8(8):765-774. doi: 10.1016/S2213-2600(20)30268-X. Epub 2020 Jun 19.
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An overview of management of intracranial hypertension in the intensive care unit.颅内高压在重症监护病房的管理概述。
J Anesth. 2020 Oct;34(5):741-757. doi: 10.1007/s00540-020-02795-7. Epub 2020 May 21.