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The Effect of Prone Positioning After Lung Transplantation

BACKGROUND: Prone positioning has become a standard therapy in acute respiratory distress syndrome to improve oxygenation and decrease mortality. However, little is known about prone positioning in lung transplant recipients. This large, singe-center analysis investigated whether prone positioning i...

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Autores principales: Frick, Anna Elisabeth, Schiefer, Judith, Maleczek, Mathias, Schwarz, Stefan, Benazzo, Alberto, Rath, Anna, Kulu, Askin, Hritcu, Richard, Faybik, Peter, Schaden, Eva, Jaksch, Peter, Tschernko, Edda, Frommlet, Florian, Markstaller, Klaus, Hoetzenecker, Konrad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Authors. Published by Elsevier Inc. on behalf of The Society of Thoracic Surgeons. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10162468/
https://www.ncbi.nlm.nih.gov/pubmed/37150273
http://dx.doi.org/10.1016/j.athoracsur.2023.04.036
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author Frick, Anna Elisabeth
Schiefer, Judith
Maleczek, Mathias
Schwarz, Stefan
Benazzo, Alberto
Rath, Anna
Kulu, Askin
Hritcu, Richard
Faybik, Peter
Schaden, Eva
Jaksch, Peter
Tschernko, Edda
Frommlet, Florian
Markstaller, Klaus
Hoetzenecker, Konrad
author_facet Frick, Anna Elisabeth
Schiefer, Judith
Maleczek, Mathias
Schwarz, Stefan
Benazzo, Alberto
Rath, Anna
Kulu, Askin
Hritcu, Richard
Faybik, Peter
Schaden, Eva
Jaksch, Peter
Tschernko, Edda
Frommlet, Florian
Markstaller, Klaus
Hoetzenecker, Konrad
author_sort Frick, Anna Elisabeth
collection PubMed
description BACKGROUND: Prone positioning has become a standard therapy in acute respiratory distress syndrome to improve oxygenation and decrease mortality. However, little is known about prone positioning in lung transplant recipients. This large, singe-center analysis investigated whether prone positioning improves gas exchange after lung transplantation. METHODS: Clinical data of 583 patients were analyzed. Prone position was considered in case of impaired gas exchange Pao(2)/fraction of oxygen in inhaled air (<250), signs of edema after lung transplantation, and/or evidence of reperfusion injury. Patients with hemodynamic instability or active bleeding were not proned. Impact of prone positioning (n = 165) on gas exchange, early outcome and survival were determined and compared with patients in supine positioning (n = 418). RESULTS: Patients in prone position were younger, more likely to have interstitial lung disease, and had a higher lung allocation score. Patients were proned for a median of 19 hours (interquartile range,15-26) hours). They had significantly lower Pao(2)/fraction of oxygen in inhaled air (227 ± 96 vs 303 ± 127 mm Hg, P = .004), and lower lung compliance (24.8 ± 9.1 mL/mbar vs 29.8 ± 9.7 mL/mbar, P < .001) immediately after lung transplantation. Both values significantly improved after prone positioning for 24 hours (Pao(2)/fraction of oxygen ratio: 331 ± 91 mm Hg; lung compliance: 31.7 ± 20.2 mL/mbar). Survival at 90 days was similar between the 2 groups (93% vs 96%, P = .105). CONCLUSIONS: Prone positioning led to a significant improvement in lung compliance and oxygenation after lung transplantation. Prospective studies are needed to confirm the benefit of prone positioning in lung transplantation.
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spelling pubmed-101624682023-05-08 The Effect of Prone Positioning After Lung Transplantation Frick, Anna Elisabeth Schiefer, Judith Maleczek, Mathias Schwarz, Stefan Benazzo, Alberto Rath, Anna Kulu, Askin Hritcu, Richard Faybik, Peter Schaden, Eva Jaksch, Peter Tschernko, Edda Frommlet, Florian Markstaller, Klaus Hoetzenecker, Konrad Ann Thorac Surg Transplant & Mechanical Support BACKGROUND: Prone positioning has become a standard therapy in acute respiratory distress syndrome to improve oxygenation and decrease mortality. However, little is known about prone positioning in lung transplant recipients. This large, singe-center analysis investigated whether prone positioning improves gas exchange after lung transplantation. METHODS: Clinical data of 583 patients were analyzed. Prone position was considered in case of impaired gas exchange Pao(2)/fraction of oxygen in inhaled air (<250), signs of edema after lung transplantation, and/or evidence of reperfusion injury. Patients with hemodynamic instability or active bleeding were not proned. Impact of prone positioning (n = 165) on gas exchange, early outcome and survival were determined and compared with patients in supine positioning (n = 418). RESULTS: Patients in prone position were younger, more likely to have interstitial lung disease, and had a higher lung allocation score. Patients were proned for a median of 19 hours (interquartile range,15-26) hours). They had significantly lower Pao(2)/fraction of oxygen in inhaled air (227 ± 96 vs 303 ± 127 mm Hg, P = .004), and lower lung compliance (24.8 ± 9.1 mL/mbar vs 29.8 ± 9.7 mL/mbar, P < .001) immediately after lung transplantation. Both values significantly improved after prone positioning for 24 hours (Pao(2)/fraction of oxygen ratio: 331 ± 91 mm Hg; lung compliance: 31.7 ± 20.2 mL/mbar). Survival at 90 days was similar between the 2 groups (93% vs 96%, P = .105). CONCLUSIONS: Prone positioning led to a significant improvement in lung compliance and oxygenation after lung transplantation. Prospective studies are needed to confirm the benefit of prone positioning in lung transplantation. The Authors. Published by Elsevier Inc. on behalf of The Society of Thoracic Surgeons. 2023-05-05 /pmc/articles/PMC10162468/ /pubmed/37150273 http://dx.doi.org/10.1016/j.athoracsur.2023.04.036 Text en © 2023 The Authors Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Transplant & Mechanical Support
Frick, Anna Elisabeth
Schiefer, Judith
Maleczek, Mathias
Schwarz, Stefan
Benazzo, Alberto
Rath, Anna
Kulu, Askin
Hritcu, Richard
Faybik, Peter
Schaden, Eva
Jaksch, Peter
Tschernko, Edda
Frommlet, Florian
Markstaller, Klaus
Hoetzenecker, Konrad
The Effect of Prone Positioning After Lung Transplantation
title The Effect of Prone Positioning After Lung Transplantation
title_full The Effect of Prone Positioning After Lung Transplantation
title_fullStr The Effect of Prone Positioning After Lung Transplantation
title_full_unstemmed The Effect of Prone Positioning After Lung Transplantation
title_short The Effect of Prone Positioning After Lung Transplantation
title_sort effect of prone positioning after lung transplantation
topic Transplant & Mechanical Support
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10162468/
https://www.ncbi.nlm.nih.gov/pubmed/37150273
http://dx.doi.org/10.1016/j.athoracsur.2023.04.036
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