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Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series
BACKGROUND: Management of H1N1 viral infection-associated acute respiratory distress syndrome (ARDS) has primarily been focused on lung protective ventilation strategies, despite that mortality remains high (up to 45%). Other measures to improve survival are prone position ventilation (PPV) and extr...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927129/ https://www.ncbi.nlm.nih.gov/pubmed/31879605 http://dx.doi.org/10.4103/IJCIIS.IJCIIS_62_18 |
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author | Sahoo, Jyoti Narayan Gurjar, Mohan Mohanty, Krantimaya Majhi, Kalpana Sradhanjali, G. |
author_facet | Sahoo, Jyoti Narayan Gurjar, Mohan Mohanty, Krantimaya Majhi, Kalpana Sradhanjali, G. |
author_sort | Sahoo, Jyoti Narayan |
collection | PubMed |
description | BACKGROUND: Management of H1N1 viral infection-associated acute respiratory distress syndrome (ARDS) has primarily been focused on lung protective ventilation strategies, despite that mortality remains high (up to 45%). Other measures to improve survival are prone position ventilation (PPV) and extracorporeal membrane oxygenation. There is scarcity of literature on the use of prone ventilation in H1N1-associated ARDS patients. METHODS: In this retrospective study, all adult patients admitted to medical intensive care unit (ICU) with H1N1 viral pneumonia having severe ARDS and requiring prone ventilation as a rescue therapy for severe hypoxemia were reviewed. The patients were considered to turn prone if PaO(2)/FiO(2) ratio was <100 cmH(2)O and PaCO(2) was >45 cmH(2)O; if no progressive improvement was seen in PaO(2)/FiO(2) over a period of 4 h, then patients were considered to turn back to supine. Measurements were obtained in supine (baseline) and PPV, after 30–60 min and then 4–6 hourly. RESULTS: Eleven adult patients with severe ARDS were ventilated in prone position. Their age range was 26–59 years. The worst PaO(2)/FiO(2) ratio range on the day of invasive ventilation was 48–100 (median 79). A total of 39 PPV sessions were done, with a range of 1–8 prone sessions per patient (median three sessions). Out of the 39 PPV sessions, PaO(2)/FiO(2) ratio and PaCO(2) responder were 38 (97.4%) and 27 (69.2%) sessions, respectively. The median ICU stay and mechanical ventilation days were 15 (range: 3–26) and 12 (range: 2–22) days, respectively. The common complication observed due to PPV was pressure ulcer. At ICU discharge, all except two patients survived. CONCLUSION: PPV improves oxygenation when started early with adequate duration and should be considered in all severe ARDS cases secondary to H1N1 viral infection. |
format | Online Article Text |
id | pubmed-6927129 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-69271292019-12-26 Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series Sahoo, Jyoti Narayan Gurjar, Mohan Mohanty, Krantimaya Majhi, Kalpana Sradhanjali, G. Int J Crit Illn Inj Sci Original Article BACKGROUND: Management of H1N1 viral infection-associated acute respiratory distress syndrome (ARDS) has primarily been focused on lung protective ventilation strategies, despite that mortality remains high (up to 45%). Other measures to improve survival are prone position ventilation (PPV) and extracorporeal membrane oxygenation. There is scarcity of literature on the use of prone ventilation in H1N1-associated ARDS patients. METHODS: In this retrospective study, all adult patients admitted to medical intensive care unit (ICU) with H1N1 viral pneumonia having severe ARDS and requiring prone ventilation as a rescue therapy for severe hypoxemia were reviewed. The patients were considered to turn prone if PaO(2)/FiO(2) ratio was <100 cmH(2)O and PaCO(2) was >45 cmH(2)O; if no progressive improvement was seen in PaO(2)/FiO(2) over a period of 4 h, then patients were considered to turn back to supine. Measurements were obtained in supine (baseline) and PPV, after 30–60 min and then 4–6 hourly. RESULTS: Eleven adult patients with severe ARDS were ventilated in prone position. Their age range was 26–59 years. The worst PaO(2)/FiO(2) ratio range on the day of invasive ventilation was 48–100 (median 79). A total of 39 PPV sessions were done, with a range of 1–8 prone sessions per patient (median three sessions). Out of the 39 PPV sessions, PaO(2)/FiO(2) ratio and PaCO(2) responder were 38 (97.4%) and 27 (69.2%) sessions, respectively. The median ICU stay and mechanical ventilation days were 15 (range: 3–26) and 12 (range: 2–22) days, respectively. The common complication observed due to PPV was pressure ulcer. At ICU discharge, all except two patients survived. CONCLUSION: PPV improves oxygenation when started early with adequate duration and should be considered in all severe ARDS cases secondary to H1N1 viral infection. Wolters Kluwer - Medknow 2019 2019-12-11 /pmc/articles/PMC6927129/ /pubmed/31879605 http://dx.doi.org/10.4103/IJCIIS.IJCIIS_62_18 Text en Copyright: © 2019 International Journal of Critical Illness and Injury Science http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Sahoo, Jyoti Narayan Gurjar, Mohan Mohanty, Krantimaya Majhi, Kalpana Sradhanjali, G. Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series |
title | Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series |
title_full | Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series |
title_fullStr | Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series |
title_full_unstemmed | Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series |
title_short | Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series |
title_sort | prone ventilation in h1n1 virus-associated severe acute respiratory distress syndrome: a case series |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927129/ https://www.ncbi.nlm.nih.gov/pubmed/31879605 http://dx.doi.org/10.4103/IJCIIS.IJCIIS_62_18 |
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