Application of prone position in hypoxemic patients supported by veno-venous ECMO

Alberto Lucchini, Christian De Felippis, Giulia Pelucchi, Giacomo Grasselli, Nicolò Patroniti, Luigi Castagna, Giuseppe Foti, Antonio Pesenti, Roberto Fumagalli

Research output: Contribution to journalArticle

Abstract

Introduction: Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is an advanced respiratory care therapy allowing replacement of pulmonary gas exchange. Despite VV-ECMO support, some patients may remain hypoxaemic. A possible therapeutic procedure for these patients is the application of prone positioning. Objective: The primary aim of the present study was to investigate modification of the PaO2/FiO2 ratio, in VV-ECMO patients with refractory hypoxaemia. The secondary aim was to evaluate the safety and feasibility of prone positioning for patients with severe Adult Respiratory Distress Syndrome supported by ECMO. Methods: We retrospectively reviewed the electronic records and charts of all patients supported by VV-ECMO who experienced at least one pronation. Complications related with prone positioning were also recorded. First PaO2/FiO2 ratio was analysed during four different time steps: before pronation, one hour after pronation, at the end of pronation and one hour after returning to supine. Results: A total of 45 prone positioning manoeuvers were performed in 14 VV-ECMO patients from November 2009 to November 2014. The median duration of prone positioning cycles was 8 h (IQR 6–10). No accidental dislodgement of intravascular lines, endotracheal tubes, chest tubes or a decrease in ECMO blood flow was observed. During the first prone positioning for each patient, the median PaO2/FiO2 ratio recorded was 123 (IQR 82–135), 152 (93–185), 149 (90–186) and 113 (74–182), during PRE-supine step, 1 h-prone positioning step, END-prone positioning step, and POST-supine step respectively. Conclusions: The application of prone positioning during VV-ECMO has shown to be a safe and reliable technique when performed in a recognised ECMO centre with the appropriately trained staff and standard procedures.

Original languageEnglish
Pages (from-to)61-68
JournalIntensive and Critical Care Nursing
Volume48
DOIs
Publication statusPublished - 2018

Fingerprint

Prone Position
Extracorporeal Membrane Oxygenation
Pronation
Patient Positioning
Pulmonary Gas Exchange
Respiratory Therapy
Chest Tubes
Adult Respiratory Distress Syndrome
Safety

Keywords

  • ARDS
  • ECLS
  • ECMO
  • Hypoxaemic patient
  • Prone position

ASJC Scopus subject areas

  • Critical Care

Cite this

Application of prone position in hypoxemic patients supported by veno-venous ECMO. / Lucchini, Alberto; De Felippis, Christian; Pelucchi, Giulia; Grasselli, Giacomo; Patroniti, Nicolò; Castagna, Luigi; Foti, Giuseppe; Pesenti, Antonio; Fumagalli, Roberto.

In: Intensive and Critical Care Nursing, Vol. 48, 2018, p. 61-68.

Research output: Contribution to journalArticle

Lucchini, A, De Felippis, C, Pelucchi, G, Grasselli, G, Patroniti, N, Castagna, L, Foti, G, Pesenti, A & Fumagalli, R 2018, 'Application of prone position in hypoxemic patients supported by veno-venous ECMO', Intensive and Critical Care Nursing, vol. 48, pp. 61-68. https://doi.org/10.1016/j.iccn.2018.04.002
Lucchini, Alberto ; De Felippis, Christian ; Pelucchi, Giulia ; Grasselli, Giacomo ; Patroniti, Nicolò ; Castagna, Luigi ; Foti, Giuseppe ; Pesenti, Antonio ; Fumagalli, Roberto. / Application of prone position in hypoxemic patients supported by veno-venous ECMO. In: Intensive and Critical Care Nursing. 2018 ; Vol. 48. pp. 61-68.
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AU - Lucchini, Alberto

AU - De Felippis, Christian

AU - Pelucchi, Giulia

AU - Grasselli, Giacomo

AU - Patroniti, Nicolò

AU - Castagna, Luigi

AU - Foti, Giuseppe

AU - Pesenti, Antonio

AU - Fumagalli, Roberto

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N2 - Introduction: Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is an advanced respiratory care therapy allowing replacement of pulmonary gas exchange. Despite VV-ECMO support, some patients may remain hypoxaemic. A possible therapeutic procedure for these patients is the application of prone positioning. Objective: The primary aim of the present study was to investigate modification of the PaO2/FiO2 ratio, in VV-ECMO patients with refractory hypoxaemia. The secondary aim was to evaluate the safety and feasibility of prone positioning for patients with severe Adult Respiratory Distress Syndrome supported by ECMO. Methods: We retrospectively reviewed the electronic records and charts of all patients supported by VV-ECMO who experienced at least one pronation. Complications related with prone positioning were also recorded. First PaO2/FiO2 ratio was analysed during four different time steps: before pronation, one hour after pronation, at the end of pronation and one hour after returning to supine. Results: A total of 45 prone positioning manoeuvers were performed in 14 VV-ECMO patients from November 2009 to November 2014. The median duration of prone positioning cycles was 8 h (IQR 6–10). No accidental dislodgement of intravascular lines, endotracheal tubes, chest tubes or a decrease in ECMO blood flow was observed. During the first prone positioning for each patient, the median PaO2/FiO2 ratio recorded was 123 (IQR 82–135), 152 (93–185), 149 (90–186) and 113 (74–182), during PRE-supine step, 1 h-prone positioning step, END-prone positioning step, and POST-supine step respectively. Conclusions: The application of prone positioning during VV-ECMO has shown to be a safe and reliable technique when performed in a recognised ECMO centre with the appropriately trained staff and standard procedures.

AB - Introduction: Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is an advanced respiratory care therapy allowing replacement of pulmonary gas exchange. Despite VV-ECMO support, some patients may remain hypoxaemic. A possible therapeutic procedure for these patients is the application of prone positioning. Objective: The primary aim of the present study was to investigate modification of the PaO2/FiO2 ratio, in VV-ECMO patients with refractory hypoxaemia. The secondary aim was to evaluate the safety and feasibility of prone positioning for patients with severe Adult Respiratory Distress Syndrome supported by ECMO. Methods: We retrospectively reviewed the electronic records and charts of all patients supported by VV-ECMO who experienced at least one pronation. Complications related with prone positioning were also recorded. First PaO2/FiO2 ratio was analysed during four different time steps: before pronation, one hour after pronation, at the end of pronation and one hour after returning to supine. Results: A total of 45 prone positioning manoeuvers were performed in 14 VV-ECMO patients from November 2009 to November 2014. The median duration of prone positioning cycles was 8 h (IQR 6–10). No accidental dislodgement of intravascular lines, endotracheal tubes, chest tubes or a decrease in ECMO blood flow was observed. During the first prone positioning for each patient, the median PaO2/FiO2 ratio recorded was 123 (IQR 82–135), 152 (93–185), 149 (90–186) and 113 (74–182), during PRE-supine step, 1 h-prone positioning step, END-prone positioning step, and POST-supine step respectively. Conclusions: The application of prone positioning during VV-ECMO has shown to be a safe and reliable technique when performed in a recognised ECMO centre with the appropriately trained staff and standard procedures.

KW - ARDS

KW - ECLS

KW - ECMO

KW - Hypoxaemic patient

KW - Prone position

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