Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2022; 10(17): 5577-5585
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5577
Clinical evaluation of prone position ventilation in the treatment of acute respiratory distress syndrome induced by sepsis
Wen-Han Xia, Chun-Li Yang, Zhi Chen, Cheng-Hong Ouyang, Guo-Quan Ouyang, Qiu-Gen Li
Wen-Han Xia, Chun-Li Yang, Cheng-Hong Ouyang, Department of Intensive Care Unit, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
Zhi Chen, Department of Emergency, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
Guo-Quan Ouyang, Qiu-Gen Li, Department of Respiratory Medicine, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Xia WH and Li QG designed this retrospective study, Xia WH and Yang CL wrote the manuscript; Xia WH, Yang CL, Chen Z, Ouyang CH and Ouyang GQ were responsible for sorting the data.
Supported by Science and Technology Plan of Jiangxi Provincial Health Commission, No. 202130095.
Institutional review board statement: The study was reviewed and approved by the ethics committee of Jiangxi Provincial People’s Hospital Affiliated to Nanchang University Institutional Review Board (Approval No. 2016ED13).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiu-Gen Li, MM, Chief Physician, Department of Respiratory Medicine, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, No. 92 Aiguo Road, Nanchang 330006, Jiangxi Province, China. liqiugen1976@163.com
Received: January 10, 2022
Peer-review started: January 10, 2022
First decision: February 14, 2022
Revised: February 26, 2022
Accepted: April 3, 2022
Article in press: April 3, 2022
Published online: June 16, 2022
Processing time: 149 Days and 23.3 Hours
Abstract
BACKGROUND

Acute respiratory distress syndrome (ARDS) is an acute, diffuse, inflammatory lung injury. Previous studies have shown prone position ventilation (PPV) to be associated with improvement in oxygenation. However, its role in patients with ARDS caused by sepsis remains unknown.

AIM

To analyze the clinical effects of PPV in patients with ARDS caused by sepsis.

METHODS

One hundred and two patients with ARDS were identified and divided into a control group (n = 55) and a PPV treatment group (n = 47). Outcomes included oxygenation index, lung compliance (Cst) and platform pressure (Pplat), which were compared between the two groups after ventilation. Other outcomes included heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), left ventricular ejection fraction (LVEF), the length of mechanical ventilation time and intensive care unit (ICU) stay, and levels of C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) after ventilation. Finally, mortality rate was also compared between the two groups.

RESULTS

On the first day after ventilation, the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group (P < 0.05). There were no significant differences in oxygenation index, Cst, and Pplat levels between the two groups on the 2nd, 4th, and 7th day after ventilation (P > 0.05). There were no significant differences in HR, MAP, CVP, LVEF, duration of mechanical ventilation and ICU stay, and the levels of CRP, PCT, and IL-6 between the two groups on the first day after ventilation (all P > 0.05). The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%, and 25.53% and 45.45%, respectively (P < 0.05).

CONCLUSION

PPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis. Finally, PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.

Keywords: Acute respiratory distress syndrome; Sepsis; Prone position; Supine position; Mechanical ventilation; Hemodynamics

Core Tip: Acute respiratory distress syndrome (ARDS) is an acute, short-onset, diffuse, inflammatory lung injury disease. Previous studies have reported on the benefits of the prone position over the supine position in terms of mechanical ventilation and oxygenation; however, this has not been addressed in patients with ARDS caused by sepsis. Herein, we retrospectively reviewed the data of 106 patients who underwent mechanical ventilation for ARDS caused by sepsis. We found that mechanical ventilation in the prone position was associated with reduced mortality with no adverse effects on inflammatory and hemodynamic indices.