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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...

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Autores principales: Sahoo, Jyoti Narayan, Gurjar, Mohan, Mohanty, Krantimaya, Majhi, Kalpana, Sradhanjali, G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2019
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.
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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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