Duration of prone position sessions: a prospective cohort study.
| Title: | Duration of prone position sessions: a prospective cohort study. |
|---|---|
| Authors: | Jochmans S; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France. sebastien.jochmans@gmail.com.; Unité de Recherche Clinique, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France. sebastien.jochmans@gmail.com.; Mazerand S; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Chelly J; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Unité de Recherche Clinique, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Pourcine F; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Sy O; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Thieulot-Rolin N; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Ellrodt O; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Mercier Des Rochettes E; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Service de Réanimation Médicale, AP-HP, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.; Michaud G; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Serbource-Goguel J; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Vinsonneau C; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Unité de Recherche Clinique, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Service de Réanimation, Hôpital de Béthune, 27 rue Delbecque, 62660, Beuvry, France.; Vong LVP; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Monchi M; Département de Médecine Intensive-Réanimation, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France.; Unité de Recherche Clinique, GH Sud Ile-de-France, Hôpital de Melun, 270 avenue Marc Jacquet, 77000, Melun, France. |
| Source: | Annals of intensive care [Ann Intensive Care] 2020 May 24; Vol. 10 (1), pp. 66. Date of Electronic Publication: 2020 May 24. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Springer-Verlag Country of Publication: Germany NLM ID: 101562873 Publication Model: Electronic Cited Medium: Print ISSN: 2110-5820 (Print) Linking ISSN: 21105820 NLM ISO Abbreviation: Ann Intensive Care Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: Heidelberg : Springer-Verlag, 2011- |
| Abstract: | 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 PaO2/FiO2 with a significant decrease in PaCO2, Pplat, phase 3 slope of the volumetric capnography, PetCO2, VD/VT-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 PaO2/FiO2 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 (NCT02816190) (https://clinicaltrials.gov/ct2/show/NCT02816190?term=propocap&rank=1). |
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| Contributed Indexing: | Keywords: Acute respiratory distress syndrome; Acute respiratory failure; Capnography; Mechanical ventilation; Prone position; Protective ventilation |
| Molecular Sequence: | ClinicalTrials.gov NCT02816190 |
| Entry Date(s): | Date Created: 20200526 Latest Revision: 20260329 |
| Update Code: | 20260329 |
| PubMed Central ID: | PMC7245995 |
| DOI: | 10.1186/s13613-020-00683-7 |
| PMID: | 32449068 |
| Database: | MEDLINE |
Journal Article