TY - JOUR
T1 - Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure
T2 - A retrospective study
AU - Scaravilli, Vittorio
AU - Grasselli, Giacomo
AU - Castagna, Luigi
AU - Zanella, Alberto
AU - Isgrò, Stefano
AU - Lucchini, Alberto
AU - Patroniti, Nicolò
AU - Bellani, Giacomo
AU - Pesenti, Antonio
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Purpose: Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distress syndrome undergoing invasive ventilation. We evaluated feasibility and efficacy of PP in awake, non-intubated, spontaneously breathing patients with hypoxemic acute respiratory failure (ARF). Material and Methods: We retrospectively studied non-intubated subjects with hypoxemic ARF treated with PP from January 2009 to December 2014. Data were extracted from medical records. Arterial blood gas analyses, respiratory rate, and hemodynamics were retrieved 1 to 2 hours before pronation (step PRE), during PP (step PRONE), and 6 to 8 hours after resupination (step POST). Results: Fifteen non-intubated ARF patients underwent 43 PP procedures. Nine subjects were immunocompromised. Twelve subjects were discharged from hospital, while 3 died. Only 2 maneuvers were interrupted, owing to patient intolerance. No complications were documented. PP did not alter respiratory rate or hemodynamics. In the subset of procedures during which the same positive end expiratory pressure and Fio2 were utilized throughout the pronation cycle (n = 18), PP improved oxygenation (Pao2/Fio2 124 ± 50 mmHg, 187 ± 72 mmHg, and 140 ± 61 mmHg, during PRE, PRONE, and POST steps, respectively, P <.001), while pH and Paco2 were unchanged. Conclusions: PP was feasible and improved oxygenation in non-intubated, spontaneously breathing patients with ARF.
AB - Purpose: Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distress syndrome undergoing invasive ventilation. We evaluated feasibility and efficacy of PP in awake, non-intubated, spontaneously breathing patients with hypoxemic acute respiratory failure (ARF). Material and Methods: We retrospectively studied non-intubated subjects with hypoxemic ARF treated with PP from January 2009 to December 2014. Data were extracted from medical records. Arterial blood gas analyses, respiratory rate, and hemodynamics were retrieved 1 to 2 hours before pronation (step PRE), during PP (step PRONE), and 6 to 8 hours after resupination (step POST). Results: Fifteen non-intubated ARF patients underwent 43 PP procedures. Nine subjects were immunocompromised. Twelve subjects were discharged from hospital, while 3 died. Only 2 maneuvers were interrupted, owing to patient intolerance. No complications were documented. PP did not alter respiratory rate or hemodynamics. In the subset of procedures during which the same positive end expiratory pressure and Fio2 were utilized throughout the pronation cycle (n = 18), PP improved oxygenation (Pao2/Fio2 124 ± 50 mmHg, 187 ± 72 mmHg, and 140 ± 61 mmHg, during PRE, PRONE, and POST steps, respectively, P <.001), while pH and Paco2 were unchanged. Conclusions: PP was feasible and improved oxygenation in non-intubated, spontaneously breathing patients with ARF.
KW - Hypoxia
KW - Noninvasive ventilation
KW - Prone position
KW - Pulmonary gas exchange
KW - Pulmonary ventilation
KW - Retrospective studies
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U2 - 10.1016/j.jcrc.2015.07.008
DO - 10.1016/j.jcrc.2015.07.008
M3 - Article
C2 - 26271685
AN - SCOPUS:84947023234
VL - 30
SP - 1390
EP - 1394
JO - Journal of Critical Care
JF - Journal of Critical Care
SN - 0883-9441
IS - 6
M1 - 51935
ER -