Effects of prone position ventilation at different angles on patients with acute respiratory distress syndrome
Objective To evaluate the effects of prone position ventilation at different angles on patients with acute respiratory distress syndrome(ARDS).Methods This prospective,randomized,controlled clinical trial included 96 patients with ARDS admitted to the Intensive Care Unit(ICU)of Guangdong Second Hospital of Traditional Chinese Medicine from July 2021 to June 2023.The patients were randomly divided into group A(0° prone position ventilation),group B(30° prone position ventilation),and group C(45° prone position ventilation),with 32 cases in each group.There were 19 males and 13 females in group A,aged(50.25±1 1.31)years,with a body mass index(BMI)of(23.42±3.16)kg/m2.There were 17 males and 15 females in group B,aged(51.93±12.48)years,with a BMI of(22.72±4.15)kg/m2.There were 20 males and 12 females in group C,aged(52.39±12.82)years,with a BMI of(24.76±4.31)kg/m2.The observation time was 5 days.The patients in group A were continuously ventilated in the prone position at 0° for 16 h every day and lifted up every 2 h to prevent stress injury.In group B,after maintaining 0° prone position for 2 h,the patients'body was tilted to the left for 30° with the 30° turning pad for 2 h,then it was tilted to the right for 30° for 2 h,finally returned to 0° prone position.This was repeated until 16 h of prone ventilation was completed.In group C,after maintaining 0° prone position for 2 h,the patients'body was tilted to the left for 45° with the 45° turning pad for 2 h,then it was tilted to the right for 45° for 2 h,finally returned to 0° prone position.This was repeated until 16 h of prone ventilation was completed.The changes in oxygenation indicators[oxygenation index(PaO2/FiO2),arterial oxygen saturation(SaO2),arterial partial pressure of oxygen(PaO2),and arterial partial pressure of carbon dioxide(PaCO2)],hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP),and central venous pressure(CVP)],Murray Lung Injury Score(MLIS),Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,and multiple organ dysfunction syndrome(MODS)score were compared among the three groups.The incidence of pressure injury was also observed.One-way analysis of variance,LSD method,paired t test,and x2 test were used.Results After 5 days of prone position ventilation,the PaO2/FiO2,SaO2,PaO2,and PaCO2 in the three groups were improved compared with those before ventilation,and the improvement ranges of group A and group B were better than those of group C(all P＜0.05).There were no statistically significant differences in the HR,MAP,or CVP among the three groups before and after 5 days of prone position ventilation(all P＞0.05).After 5 days of prone position ventilation,the MLIS,APACHE Ⅱ,and MODS scores of the three groups were lower than those before ventilation;those of group A and group B were lower than those of group C[(1.72±0.37)points vs.(1.54±0.16)points vs.(1.89±0.26)points,(11.02±2.69)points vs.(11.01±2.01)points vs.(12.87±2.06)points,(5.64±0.37)points vs.(5.34±0.67)points vs.(6.19±0.43)points](all P＜0.05).The incidences of pressure injury in group B and group C were lower than that in group A[15.63％(5/32)vs.18.75％(6/32)vs.40.63％(13/32)](P＜0.05).Conclusions Prone position ventilation at different angles can improve the oxygenation and alleviate the condition in patients with ARDS.Among the studied angles,30° prone position ventilation shows the most significant improvement and reduces the incidence of pressure injury.
Acute respiratory distress syndromeProne position ventilationDifferent anglesOxygenation indexHemodynamicsPressure injury
万方数据
维普
