Prone position in ARDS patients: why, when, how and for whom

被引：283

作者：

Guerin, Claude ^{[1
,2
,3
]}

Albert, Richard K. ^{[4
]}

Beitler, Jeremy ^{[5
,6
,7
,8
]}

Gattinoni, Luciano ^{[9
]}

Jaber, Samir ^{[10
]}

Marini, John J. ^{[11
,12
]}

Munshi, Laveena ^{[13
]}

Papazian, Laurent ^{[14
,15
]}

Pesenti, Antonio ^{[16
]}

Vieillard-Baron, Antoine ^{[17
,18
]}

Mancebo, Jordi ^{[19
]}

机构：

[1] Hop Edoudard Herriot, Med Intens Reanimat, Lyon, France

[2] Univ Lyon, Lyon, France

[3] CNRS, INSERM 955, ERL 7000, Inst Mondor Rech Medicale, Creteil, France

[4] Univ Colorado, Dept Med, Aurora, CO USA

[5] Columbia Univ, Ctr Acute Resp Failure, New York, NY USA

[6] Columbia Univ, Div Pulm, New York, NY USA

[7] Columbia Univ, Div Allergy, New York, NY USA

[8] Columbia Univ, Div Crit Care Med, New York, NY USA

[9] Univ Gottingen, Dept Anesthesiol Emergency & Intens Care Med, Gottingen, Germany

[10] Univ Montpellier, CHU Montpellier, Hop St Eloi, Crit Care & Anesthesia Dept DAR B,PhyMedExp, Montpellier, France

[11] Reg Hosp, Dept Crit Care Med, Minneapolis, MN USA

[12] Univ Minnesota, Minneapolis, MN USA

[13] Univ Toronto, Mt Sinai Hosp, Sinai Hlth Syst, Interdept Div Crit Care Med, Toronto, ON, Canada

[14] Hop Nord Marseille, AP HM, Med Intens Reanimat, F-13015 Marseille, France

[15] Aix Marseille Univ, Grp Rech Reanimat & Anesthesie Marseille Pluridis, Ctr Etud & Rech Serv Sante & Qualite Vie, Fac Med,EA 3279, F-13005 Marseille, France

[16] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dipartimento Anestesia Rianimaz & Emergenza Urgen, Milan, Italy

[17] Univ Hosp Ambroise Pare, AP HP, Boulogne, France

[18] Univ Versailles St Quentin Yvelines, UMR 1018, Boulogne, France

[19] Hosp Univ St Pau, Serv Med Intens, Barcelona, Spain

来源：

INTENSIVE CARE MEDICINE | 2020年 / 46卷 / 12期

关键词：

Acute respiratory distress syndrome; Prone position; Lung protective ventilation; Ventilation; perfusion; Gravity; RESPIRATORY-DISTRESS-SYNDROME; INHALED NITRIC-OXIDE; LUNG INJURY; INTRAABDOMINAL PRESSURE; GAS-EXCHANGE; OXYGENATION; VENTILATION; RECRUITMENT; MORTALITY; PULMONARY;

D O I：

10.1007/s00134-020-06306-w

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

In ARDS patients, the change from supine to prone position generates a more even distribution of the gas-tissue ratios along the dependent-nondependent axis and a more homogeneous distribution of lung stress and strain. The change to prone position is generally accompanied by a marked improvement in arterial blood gases, which is mainly due to a better overall ventilation/perfusion matching. Improvement in oxygenation and reduction in mortality are the main reasons to implement prone position in patients with ARDS. The main reason explaining a decreased mortality is less overdistension in non-dependent lung regions and less cyclical opening and closing in dependent lung regions. The only absolute contraindication for implementing prone position is an unstable spinal fracture. The maneuver to change from supine to prone and vice versa requires a skilled team of 4-5 caregivers. The most frequent adverse events are pressure sores and facial edema. Recently, the use of prone position has been extended to non-intubated spontaneously breathing patients affected with COVID-19 ARDS. The effects of this intervention on outcomes are still uncertain.

引用

页码：2385 / 2396

页数：12

共 77 条

[1] An updated study-level meta-analysis of randomised controlled trials on proning in ARDS and acute lung injury [J].