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Hemodynamic effects of extended prone position sessions in ARDS

BACKGROUND: Hemodynamic response to prone position (PP) has never been studied in a large series of patients with acute respiratory distress syndrome (ARDS). The primary aim of this study was to estimate the rate of PP sessions associated with cardiac index improvement. Secondary objective was to de...

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Autores principales: Ruste, Martin, Bitker, Laurent, Yonis, Hodane, Riad, Zakaria, Louf-Durier, Aurore, Lissonde, Floriane, Perinel-Ragey, Sophie, Guerin, Claude, Richard, Jean-Christophe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286298/
https://www.ncbi.nlm.nih.gov/pubmed/30535921
http://dx.doi.org/10.1186/s13613-018-0464-9
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author Ruste, Martin
Bitker, Laurent
Yonis, Hodane
Riad, Zakaria
Louf-Durier, Aurore
Lissonde, Floriane
Perinel-Ragey, Sophie
Guerin, Claude
Richard, Jean-Christophe
author_facet Ruste, Martin
Bitker, Laurent
Yonis, Hodane
Riad, Zakaria
Louf-Durier, Aurore
Lissonde, Floriane
Perinel-Ragey, Sophie
Guerin, Claude
Richard, Jean-Christophe
author_sort Ruste, Martin
collection PubMed
description BACKGROUND: Hemodynamic response to prone position (PP) has never been studied in a large series of patients with acute respiratory distress syndrome (ARDS). The primary aim of this study was to estimate the rate of PP sessions associated with cardiac index improvement. Secondary objective was to describe hemodynamic response to PP and during the shift from PP to supine position. METHODS: The study was a single-center retrospective observational study, performed on ARDS patients, undergoing at least one PP session under monitoring by transpulmonary thermodilution. PP sessions performed more than 10 days after ARDS onset, or with any missing cardiac index measurements before (T(1)), at the end (T(3)), and after the PP session (T(4)) were excluded. Changes in hemodynamic parameters during PP were tested after statistical adjustment for volume of fluid challenges, vasopressor and dobutamine dose at each time point to take into account therapeutic changes during PP sessions. RESULTS: In total, 107 patients fulfilled the inclusion criteria, totalizing 197 PP sessions. Changes in cardiac index between T(1) and T(2) (early response to PP) and between T(1) and T(3) (late response to PP) were significantly correlated (R(2) = 0.42, p < 0.001) with a concordance rate amounting to 85%. Cardiac index increased significantly between T(1) and T(3) in 49 sessions (25% [95% confidence interval (CI(95%)) 18–32%]), decreased significantly in 46 (23% [CI(95%) 16–31%]), and remained stable in 102 (52% [CI(95%) 45–59%]). Global end-diastolic volume index (GEDVI) increased slightly but significantly from 719 ± 193 mL m(−2) at T(1) to 757 ± 209 mL m(−2) at T(3) and returned to baseline values at T(4). Cardiac index and oxygen delivery decreased slightly but significantly from T(3) to T(4), without detectable increase in lactate level. Patients who increased their cardiac index during PP had significantly lower CI, GEDVI, global ejection fraction at T(1), and received significantly more fluids than patients who did not. CONCLUSION: PP is associated with an increase in cardiac index in 18% to 32% of all PP sessions and a sustained increase in GEDVI reversible after return to supine position. Return from prone to supine position is associated with a slight hemodynamic impairment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-018-0464-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-62862982018-12-26 Hemodynamic effects of extended prone position sessions in ARDS Ruste, Martin Bitker, Laurent Yonis, Hodane Riad, Zakaria Louf-Durier, Aurore Lissonde, Floriane Perinel-Ragey, Sophie Guerin, Claude Richard, Jean-Christophe Ann Intensive Care Research BACKGROUND: Hemodynamic response to prone position (PP) has never been studied in a large series of patients with acute respiratory distress syndrome (ARDS). The primary aim of this study was to estimate the rate of PP sessions associated with cardiac index improvement. Secondary objective was to describe hemodynamic response to PP and during the shift from PP to supine position. METHODS: The study was a single-center retrospective observational study, performed on ARDS patients, undergoing at least one PP session under monitoring by transpulmonary thermodilution. PP sessions performed more than 10 days after ARDS onset, or with any missing cardiac index measurements before (T(1)), at the end (T(3)), and after the PP session (T(4)) were excluded. Changes in hemodynamic parameters during PP were tested after statistical adjustment for volume of fluid challenges, vasopressor and dobutamine dose at each time point to take into account therapeutic changes during PP sessions. RESULTS: In total, 107 patients fulfilled the inclusion criteria, totalizing 197 PP sessions. Changes in cardiac index between T(1) and T(2) (early response to PP) and between T(1) and T(3) (late response to PP) were significantly correlated (R(2) = 0.42, p < 0.001) with a concordance rate amounting to 85%. Cardiac index increased significantly between T(1) and T(3) in 49 sessions (25% [95% confidence interval (CI(95%)) 18–32%]), decreased significantly in 46 (23% [CI(95%) 16–31%]), and remained stable in 102 (52% [CI(95%) 45–59%]). Global end-diastolic volume index (GEDVI) increased slightly but significantly from 719 ± 193 mL m(−2) at T(1) to 757 ± 209 mL m(−2) at T(3) and returned to baseline values at T(4). Cardiac index and oxygen delivery decreased slightly but significantly from T(3) to T(4), without detectable increase in lactate level. Patients who increased their cardiac index during PP had significantly lower CI, GEDVI, global ejection fraction at T(1), and received significantly more fluids than patients who did not. CONCLUSION: PP is associated with an increase in cardiac index in 18% to 32% of all PP sessions and a sustained increase in GEDVI reversible after return to supine position. Return from prone to supine position is associated with a slight hemodynamic impairment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13613-018-0464-9) contains supplementary material, which is available to authorized users. Springer International Publishing 2018-12-07 /pmc/articles/PMC6286298/ /pubmed/30535921 http://dx.doi.org/10.1186/s13613-018-0464-9 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Ruste, Martin
Bitker, Laurent
Yonis, Hodane
Riad, Zakaria
Louf-Durier, Aurore
Lissonde, Floriane
Perinel-Ragey, Sophie
Guerin, Claude
Richard, Jean-Christophe
Hemodynamic effects of extended prone position sessions in ARDS
title Hemodynamic effects of extended prone position sessions in ARDS
title_full Hemodynamic effects of extended prone position sessions in ARDS
title_fullStr Hemodynamic effects of extended prone position sessions in ARDS
title_full_unstemmed Hemodynamic effects of extended prone position sessions in ARDS
title_short Hemodynamic effects of extended prone position sessions in ARDS
title_sort hemodynamic effects of extended prone position sessions in ards
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286298/
https://www.ncbi.nlm.nih.gov/pubmed/30535921
http://dx.doi.org/10.1186/s13613-018-0464-9
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