Application of prone position in the treatment of patients with acute respiratory distress syndrome caused by pulmonary contusion_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 LIU Xiaoyi ¹ , LIU Hui ² , RAN Hui ¹ , ZHOU Wenlai ¹ , LAN Qing ¹ , ZHOU Rui ¹ , ZHENG Xiangde ¹

1. Department of Critical Care Medicine, The Central Hospital of Dazhou, Dazhou, Sichuan 635000, P. R. China;
2. Department of Ophthalmology, The Central Hospital of Dazhou, Dazhou, Sichuan 635000, P. R. China;

Corresponding author：

LIU Xiaoyi, Email: 756904123@qq.com

Keywords：

Prone position; Pulmonary contusion; Acute respiratory distress syndrome; Mechanical ventilation; Hypoxemia

DOI：

10.7507/1671-6205.202105054

Video：

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Objective To explore the clinical significance of prone position in the treatment of patients with acute respiratory distress syndrome (ARDS) caused by pulmonary contusion.Methods A retrospective analysis was conducted on pulmonary contusion patients in the Intensive Care Medicine (ICU) from January 2017 to April 2021. The patients were divided into a prone position group (n=121) and a control group (n=117) after screening. The patients' basic conditions, occurrence of ARDS (P/F<150 mm Hg), changes in vital signs, laboratory examinations, lung compliance and other changes after treatment, mechanical ventilation time, staying in ICU, complications, and mortality were recorded and conpared between the two groups.Results When ARDS [oxygenation index (P/F)<150 mm Hg] occurred, compared with 1 day later, the P/F [(125.7±15.3) vs. (209.5±22.4) mm Hg , P<0.05] and lung compliance [(64.6±4.8) vs. (76.0±5.4) mL/cm H₂O, P<0.05] increased in the prone position group. Compare with the control group after 1 day of treatment ARDS (P/F<150 mm Hg), P/F [(209.5±22.4) vs. (126.1±19.5) mm Hg, P<0.05] and lung compliance [(76.0±5.4) vs. (63.5±5.5) mL/cm H₂O, P<0.05] increased in the prone position group (P<0.05). Compare with the control group, the prone position group had shortened mechanical ventilation time and ICU stay time, less atelectasis, lower mortality (P<0.05), lower occurrence of pneumothorax (P>0.05).Conclusion Prone position treatment for patients with pulmonary contusion after ARDS (P/F<150 mm Hg) can correct hypoxemia faster, improve lung compliance, reduce atelectasis, shorten mechanical ventilation time and stay time of ICU, and reduce mortality, hence it has clinical value.

Citation： LIU Xiaoyi, LIU Hui, RAN Hui, ZHOU Wenlai, LAN Qing, ZHOU Rui, ZHENG Xiangde. Application of prone position in the treatment of patients with acute respiratory distress syndrome caused by pulmonary contusion. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(6): 403-407. doi: 10.7507/1671-6205.202105054 Copy

1.	Keskin Y, Bedel C, Gökben Beceren N. Investigation of histopathological and radiological effects of surfactant treatment in an experimental female rat model of lung contusion. Iran J Basic Med Sci, 2019, 22(10): 1153-1157.
2.	Medar Shivanand S, Villacres S, Kaushik S, et al. Pediatric acute respiratory distress syndrome (pards) in children with pulmonary contusion. Intensive Care Med, 2021, 36(1): 107-114.
3.	Morris B, Fritz M, Hans Werner K, et al. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World J Emerg Surg, 2020, 15(1): 523-526.
4.	Sabri D, Ahmet E, Yasemin Dere G, et al. Contribution of bone marrow–derived mesenchymal stem cells to healing of pulmonary contusion-created rats. J Surg Res, 2021, 261: 205-214.
5.	乔弟, 王强, 张永明, 等. 依达拉奉联合乌司他丁治疗严重肺挫伤对 HMGB1、sE-选择素和 sCD14 水平的影响. 河北医药, 2021, 43(2): 196-200.
6.	漆敏, 倪忠, 唐永江, 等. 清醒俯卧位通气策略在低氧性呼吸衰竭患者中的应用进展. 中国呼吸与危重监护杂志, 2021, 20(3): 215-218.
7.	Andrea C, Agnese Damia P, Benedetto M, et al. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Critical Care, 2020, 24(1): 2159-2168.
8.	Liu XY, Liu H, Lan Q, et al. Early prone positioning therapy for patients with mild coronavirus disease 2019. Med Clin (Balc), 2021, 156(8): 386-389.
9.	Definition Task Force ARDS, Ranieri VM, Rubenfeld GD, et al. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
10.	杨毅, 邱海波. 急性呼吸窘迫综合征救治: 需要遵循的十大原则. 中华重症医学电子杂志(网络版), 2015, 1(1): 33-38.
11.	Fan E, Del Sorbo L, Goligher EC, et al; American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med, 2017, 195(9): 1253-1263.
12.	Zhou YF, Jin XD, Lv YX, et al. Early application of airway pressure release ventilation in acute respiratory distress syndrome. Intensive Care Med, 2017, 43: 1648-1659.
13.	Beshay M, Mertzlufft F, Kottkamp HW, et al. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World J Emerg Surg, 2020, 15(1): 45.
14.	孟毅, 杨侃, 王向阳, 等. 肺挫伤致急性呼吸窘迫综合征临床分析. 创伤外科杂志, 2004, 6(4): 263-265.
15.	Pelosi P, Cadringher P, Bottino N, et al. Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med, 1999, 159(3): 872-880.
16.	解立新, 刘又宁, 赵晓巍, 等. 俯卧位通气对肺内和肺外不同源性急性呼吸窘迫综合征犬外周血和支气管肺泡灌洗液中炎性介质的影响. 中华医学杂志, 2004, 84(14): 1200-1204.
17.	Famous KR, Delucchi K, Ware LB, et al. Acute respiratory distress syndrome subphenotypes respond differently to randomized fluid management strategy. Am J Respir Crit Care Med, 2017, 195(3): 331-338.
18.	Sinha P, Delucchi KL, Thompson BT, et al. Latent class analysis of ARDS subphenotypes: a secondary analysis of the statins for acutely injured lungs from sepsis (SAILS) study. Intensive Care Med, 2018, 44(11): 1859-1869.

1. Keskin Y, Bedel C, Gökben Beceren N. Investigation of histopathological and radiological effects of surfactant treatment in an experimental female rat model of lung contusion. Iran J Basic Med Sci, 2019, 22(10): 1153-1157.
2. Medar Shivanand S, Villacres S, Kaushik S, et al. Pediatric acute respiratory distress syndrome (pards) in children with pulmonary contusion. Intensive Care Med, 2021, 36(1): 107-114.
3. Morris B, Fritz M, Hans Werner K, et al. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World J Emerg Surg, 2020, 15(1): 523-526.
4. Sabri D, Ahmet E, Yasemin Dere G, et al. Contribution of bone marrow–derived mesenchymal stem cells to healing of pulmonary contusion-created rats. J Surg Res, 2021, 261: 205-214.
5. 乔弟, 王强, 张永明, 等. 依达拉奉联合乌司他丁治疗严重肺挫伤对 HMGB1、sE-选择素和 sCD14 水平的影响. 河北医药, 2021, 43(2): 196-200.
6. 漆敏, 倪忠, 唐永江, 等. 清醒俯卧位通气策略在低氧性呼吸衰竭患者中的应用进展. 中国呼吸与危重监护杂志, 2021, 20(3): 215-218.
7. Andrea C, Agnese Damia P, Benedetto M, et al. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Critical Care, 2020, 24(1): 2159-2168.
8. Liu XY, Liu H, Lan Q, et al. Early prone positioning therapy for patients with mild coronavirus disease 2019. Med Clin (Balc), 2021, 156(8): 386-389.
9. Definition Task Force ARDS, Ranieri VM, Rubenfeld GD, et al. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
10. 杨毅, 邱海波. 急性呼吸窘迫综合征救治: 需要遵循的十大原则. 中华重症医学电子杂志(网络版), 2015, 1(1): 33-38.
11. Fan E, Del Sorbo L, Goligher EC, et al; American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med, 2017, 195(9): 1253-1263.
12. Zhou YF, Jin XD, Lv YX, et al. Early application of airway pressure release ventilation in acute respiratory distress syndrome. Intensive Care Med, 2017, 43: 1648-1659.
13. Beshay M, Mertzlufft F, Kottkamp HW, et al. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World J Emerg Surg, 2020, 15(1): 45.
14. 孟毅, 杨侃, 王向阳, 等. 肺挫伤致急性呼吸窘迫综合征临床分析. 创伤外科杂志, 2004, 6(4): 263-265.
15. Pelosi P, Cadringher P, Bottino N, et al. Sigh in acute respiratory distress syndrome. Am J Respir Crit Care Med, 1999, 159(3): 872-880.
16. 解立新, 刘又宁, 赵晓巍, 等. 俯卧位通气对肺内和肺外不同源性急性呼吸窘迫综合征犬外周血和支气管肺泡灌洗液中炎性介质的影响. 中华医学杂志, 2004, 84(14): 1200-1204.
17. Famous KR, Delucchi K, Ware LB, et al. Acute respiratory distress syndrome subphenotypes respond differently to randomized fluid management strategy. Am J Respir Crit Care Med, 2017, 195(3): 331-338.
18. Sinha P, Delucchi KL, Thompson BT, et al. Latent class analysis of ARDS subphenotypes: a secondary analysis of the statins for acutely injured lungs from sepsis (SAILS) study. Intensive Care Med, 2018, 44(11): 1859-1869.

Chinese Journal of Respiratory and Critical Care Medicine

Application of prone position in the treatment of patients with acute respiratory distress syndrome caused by pulmonary contusion

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