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Duration of prone position sessions: a prospective cohort study
BACKGROUND: Prone position (PP) is highly recommended in moderate-to-severe ARDS. However, the optimal duration of PP sessions remains unclear. We searched to evaluate the time required to obtain the maximum physiological effect, and to search for parameters related to patient survival in PP. METHOD...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245995/ https://www.ncbi.nlm.nih.gov/pubmed/32449068 http://dx.doi.org/10.1186/s13613-020-00683-7 |
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author | Jochmans, Sebastien Mazerand, Sandie Chelly, Jonathan Pourcine, Franck Sy, Oumar Thieulot-Rolin, Nathalie Ellrodt, Olivier Mercier Des Rochettes, Emmanuelle Michaud, Gaël Serbource-Goguel, Jean Vinsonneau, Christophe Vong, Ly Van Phach Monchi, Mehran |
author_facet | Jochmans, Sebastien Mazerand, Sandie Chelly, Jonathan Pourcine, Franck Sy, Oumar Thieulot-Rolin, Nathalie Ellrodt, Olivier Mercier Des Rochettes, Emmanuelle Michaud, Gaël Serbource-Goguel, Jean Vinsonneau, Christophe Vong, Ly Van Phach Monchi, Mehran |
author_sort | Jochmans, Sebastien |
collection | PubMed |
description | BACKGROUND: Prone position (PP) is highly recommended in moderate-to-severe ARDS. However, the optimal duration of PP sessions remains unclear. We searched to evaluate the time required to obtain the maximum physiological effect, and to search for parameters related to patient survival in PP. METHODS AND RESULTS: It was a prospective, monocentric, physiological study. We included in the study all prone-positioned patients in our ICU between June 2016 and January 2018. Pulmonary mechanics, data from volumetric capnography and arterial blood gas were recorded before prone positioning, 2 h after proning, before return to a supine position (SP) and 2 h after return to SP. Dynamic parameters were recorded before proning and every 30 min during the session until 24 h. 103 patients (ARDS 95%) were included performing 231 PP sessions with a mean length of 21.5 ± 5 h per session. They presented a significant increase in pH, static compliance and P(a)O(2)/F(i)O(2) with a significant decrease in P(a)CO(2), P(plat), phase 3 slope of the volumetric capnography, P(et)CO(2), V(D)/V(T-phy) and ΔP. The beneficial physiological effects continued after 16 h of PP and at least up to 24 h in some patients. The evolution of the respiratory parameters during the first session and also during the pooled sessions did not find any predictor of response to PP, whether before, during or 2 h after the return in SP. CONCLUSIONS: PP sessions should be prolonged at least 24 h and be extended in the event that the P(a)O(2)/F(i)O(2) ratio at 24 h remains below 150, especially since no criteria can predict which patient will benefit or not from it. Trial registration The trial has been registered on 28 June 2016 in ClinicalTrials.gov (NCT 02816190) (https://clinicaltrials.gov/ct2/show/NCT02816190?term=propocap&rank=1). |
format | Online Article Text |
id | pubmed-7245995 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-72459952020-05-26 Duration of prone position sessions: a prospective cohort study Jochmans, Sebastien Mazerand, Sandie Chelly, Jonathan Pourcine, Franck Sy, Oumar Thieulot-Rolin, Nathalie Ellrodt, Olivier Mercier Des Rochettes, Emmanuelle Michaud, Gaël Serbource-Goguel, Jean Vinsonneau, Christophe Vong, Ly Van Phach Monchi, Mehran Ann Intensive Care Research BACKGROUND: Prone position (PP) is highly recommended in moderate-to-severe ARDS. However, the optimal duration of PP sessions remains unclear. We searched to evaluate the time required to obtain the maximum physiological effect, and to search for parameters related to patient survival in PP. METHODS AND RESULTS: It was a prospective, monocentric, physiological study. We included in the study all prone-positioned patients in our ICU between June 2016 and January 2018. Pulmonary mechanics, data from volumetric capnography and arterial blood gas were recorded before prone positioning, 2 h after proning, before return to a supine position (SP) and 2 h after return to SP. Dynamic parameters were recorded before proning and every 30 min during the session until 24 h. 103 patients (ARDS 95%) were included performing 231 PP sessions with a mean length of 21.5 ± 5 h per session. They presented a significant increase in pH, static compliance and P(a)O(2)/F(i)O(2) with a significant decrease in P(a)CO(2), P(plat), phase 3 slope of the volumetric capnography, P(et)CO(2), V(D)/V(T-phy) and ΔP. The beneficial physiological effects continued after 16 h of PP and at least up to 24 h in some patients. The evolution of the respiratory parameters during the first session and also during the pooled sessions did not find any predictor of response to PP, whether before, during or 2 h after the return in SP. CONCLUSIONS: PP sessions should be prolonged at least 24 h and be extended in the event that the P(a)O(2)/F(i)O(2) ratio at 24 h remains below 150, especially since no criteria can predict which patient will benefit or not from it. Trial registration The trial has been registered on 28 June 2016 in ClinicalTrials.gov (NCT 02816190) (https://clinicaltrials.gov/ct2/show/NCT02816190?term=propocap&rank=1). Springer International Publishing 2020-05-24 /pmc/articles/PMC7245995/ /pubmed/32449068 http://dx.doi.org/10.1186/s13613-020-00683-7 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Research Jochmans, Sebastien Mazerand, Sandie Chelly, Jonathan Pourcine, Franck Sy, Oumar Thieulot-Rolin, Nathalie Ellrodt, Olivier Mercier Des Rochettes, Emmanuelle Michaud, Gaël Serbource-Goguel, Jean Vinsonneau, Christophe Vong, Ly Van Phach Monchi, Mehran Duration of prone position sessions: a prospective cohort study |
title | Duration of prone position sessions: a prospective cohort study |
title_full | Duration of prone position sessions: a prospective cohort study |
title_fullStr | Duration of prone position sessions: a prospective cohort study |
title_full_unstemmed | Duration of prone position sessions: a prospective cohort study |
title_short | Duration of prone position sessions: a prospective cohort study |
title_sort | duration of prone position sessions: a prospective cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245995/ https://www.ncbi.nlm.nih.gov/pubmed/32449068 http://dx.doi.org/10.1186/s13613-020-00683-7 |
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