Clinical evaluation of prone position ventilation in the treatment of acute respiratory distress syndrome induced by sepsis

Wen-Han Xia; Chun-Li Yang; Zhi Chen; Cheng-Hong Ouyang; Guo-Quan Ouyang; Qiu-Gen Li

doi:10.12998/wjcc.v10.i17.5577

Clinical evaluation of prone position ventilation in the treatment of acute respiratory distress syndrome induced by sepsis

World J Clin Cases. 2022 Jun 16;10(17):5577-5585. doi: 10.12998/wjcc.v10.i17.5577.

Authors

Wen-Han Xia¹, Chun-Li Yang¹, Zhi Chen², Cheng-Hong Ouyang¹, Guo-Quan Ouyang³, Qiu-Gen Li⁴

Affiliations

¹ Department of Intensive Care Unit, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China.
² Department of Emergency, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China.
³ Department of Respiratory Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China.
⁴ Department of Respiratory Medicine, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China. liqiugen1976@163.com.

Abstract

Background: Acute respiratory distress syndrome (ARDS) is an acute, diffuse, inflammatory lung injury. Previous studies have shown prone position ventilation (PPV) to be associated with improvement in oxygenation. However, its role in patients with ARDS caused by sepsis remains unknown.

Aim: To analyze the clinical effects of PPV in patients with ARDS caused by sepsis.

Methods: One hundred and two patients with ARDS were identified and divided into a control group (n = 55) and a PPV treatment group (n = 47). Outcomes included oxygenation index, lung compliance (Cst) and platform pressure (Pplat), which were compared between the two groups after ventilation. Other outcomes included heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), left ventricular ejection fraction (LVEF), the length of mechanical ventilation time and intensive care unit (ICU) stay, and levels of C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) after ventilation. Finally, mortality rate was also compared between the two groups.

Results: On the first day after ventilation, the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group (P < 0.05). There were no significant differences in oxygenation index, Cst, and Pplat levels between the two groups on the 2^nd, 4^th, and 7^th day after ventilation (P > 0.05). There were no significant differences in HR, MAP, CVP, LVEF, duration of mechanical ventilation and ICU stay, and the levels of CRP, PCT, and IL-6 between the two groups on the first day after ventilation (all P > 0.05). The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%, and 25.53% and 45.45%, respectively (P < 0.05).

Conclusion: PPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis. Finally, PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.

Keywords: Acute respiratory distress syndrome; Hemodynamics; Mechanical ventilation; Prone position; Sepsis; Supine position.