Effect of Prone Position Ventilation on Hemodynamics in Patients with Interstitial Lung Disease Concurrent with Acute Respiratory Distress Syndrome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ChenSibei , YuYuheng , LiuDongdong , ZhangJie , YangChun , SangLing , XuYonghao , SunQingwen , NongLingbo , XuYuanda , LiuXiaoqing , LiYimin ,  HeWeiqun

Department of Critical Care Medicine, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China;

Corresponding?author：

HeWeiqun, Email: heweiqun@126.com

Keywords：

Prone position ventilation; Interstitial lung disease; Acute respiratory distress syndrome; Hemodynamics

DOI：

10.7507/1671-6205.2016031

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Objective To investigate the effect of prone position ventilation (PPV) on hemodynamics in patients with interstitial lung disease (ILD) concurrent with acute respiratory distress syndrome (ARDS) or not. Methods Severe ARDS patients received PPV treatment in intensive care unit from 2013 to 2015 were retrospectively analyzed. Pulse index continuous cardiac output (PiCCO) monitoring indices were compared 2h before PPV (PPV-2), in-PPV (PPVmean) and 2h after turn back to supine position (PPV+2), including mean arterial pressure (MAP), cardiac index (CI), intrathoracic blood volume index (ITBVI), etc. Heart function, liver function, renal function, coagulative function were compared before and after all the PPV treatment. Results Thirty-six severe pulmonary ARDS patients were recruited. Norepinephrine (NE) dose was (0.14±0.10) μg·kg^-1·min^-1 and lactate concentration was (1.70±0.57) mmol/L before PPV. CI in all the patients was increased [(4.06±0.95) L·min^-1·m^-2 vs. (3.98±1.05) L·min^-1·m^-2, P > 0.05) and central venous oxygen saturation, ITBVI [(76.94±8.94)% vs. (70.67±8.23)%, (982.17±245.87) mL/m² vs. (912.97±177.65) mL/m², P < 0.05)] were significantly increased compared with PPV-2, while heart rate (HR), MAP, urine volume were decreased (P > 0.05). The patients were divided into an ILD group (n=17) andanon-ILD group (n=19),and no significant differences were found in baseline data between two groups. Compared with PPV-2, MAP was significant decreased at PPV+2 [(85.44±10.84) mm Hg vs. (89.21±10.92) mm Hg, P < 0.05) in the ILD group. Compared with PPVmean, CI was obviously declined at PPV+2 in the ILD group. Activated partial thromboplastin time was increased [(67.04±97.52)s vs. (41.24±8.72) s, P < 0.05] and BUN was higher [(10.64±4.95) μmol/L vs. (8.18±3.88) μmol/L, P < 0.05] in the ILD group, while no significant difference was found in the non-ILD group. Conclusion PPV will not affect cardiac output in severe ARDS patients with ILD. It can increase venous return and improve tissue perfusion, but the perfusion of the abdomen organ need to be monitored cautiously.

Citation： ChenSibei, YuYuheng, LiuDongdong, ZhangJie, YangChun, SangLing, XuYonghao, SunQingwen, NongLingbo, XuYuanda, LiuXiaoqing, LiYimin, HeWeiqun. Effect of Prone Position Ventilation on Hemodynamics in Patients with Interstitial Lung Disease Concurrent with Acute Respiratory Distress Syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(2): 127-132. doi: 10.7507/1671-6205.2016031 Copy

1.	?ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al.Acute respiratory distress syndrome: the Berlin Definition.JAMA, 2012, 307: 2526-2533.
2.	Diaz JV, Brower R, Calfee CS, et al.Therapeutic strategies for severe acute lung injury.Crit Care Med, 2010, 38: 1644-1650.
3.	Gattinoni L, Taccone P, Carlesso E, et al.Prone position in acute respiratory distress syndrome.Rationale, indications, and limits.Am J Respir Crit Care Med, 2013, 188: 1286-1293.
4.	Ball C, Adams J, Boyce S, et al.Clinical guidelines for the use of the prone position in acute respiratory distress syndrome.Intensive Crit Care Nurs, 2001, 17: 94-104.
5.	萬獻堯, 黃偉, 張久之,等.急性呼吸窘迫綜合征機械通氣患者院內死亡的危險因素分析.中國呼吸與危重監護雜志, 2006, 5: 4-6.
6.	宋鵬, 李琦, 王長征,等.17例重癥急性呼吸窘迫綜合征臨床資料回顧性分析.中國呼吸與危重監護雜志, 2006, 5: 35-38.
7.	Sud S, Friedrich JO, Adhikari NK, et al.Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis.CMAJ, 2014, 186: E381-E390.
8.	Hu SL, He HL, Pan C, et al.The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials.Crit Care, 2014, 18: R109.
9.	韓炳智, 韓韜, 吳志峰.重癥吸入性肺炎合并ARDS患者行俯臥位機械通氣時氧合、血流動力學及氣道引流的研究.中國呼吸與危重監護雜志, 2014, 13: 78-81.
10.	潘亮, 馬迎民, 劉又寧,等.采用壓力支持方式進行俯臥位通氣對急性呼吸窘迫綜合征的影響(附一例報告).中國呼吸與危重監護雜志, 2004, 3: 190-191.
11.	Douglas WW, Rehder K, Froukje MB, et al.Improved oxygenation in patients with acute respiratory distress syndrome.Am Rev Respir Dis, 1974, 115: 559-566.
12.	Jozwiak M, Teboul J L, Anguel N, et al.Beneficial hemodynamic effects of prone positioning in patients with acute respiratory distress syndrome.Am J Respir Crit Care Med, 2013, 188: 1428-1433.
13.	Orchard CH, Sanchez de Leon R, Sykes MK.The relationship between hypoxic pulmonary vasoconstriction and arterial oxygen tension in the intact dog.J Physiol, 1983, 338: 61-74.
14.	Vieillard-Baron A, Charron C, Caille V, et al.Prone positioning unloads the right ventricle in severe ARDS.Chest, 2007, 132: 1440-1446.
15.	Kobirumaki-Shimozawa F, Inoue T, Shintani SA, et al.Cardiac thin filament regulation and the Frank-Starling mechanism.J Physiol Sci, 2014, 64: 221-232.
16.	Hering R, Wrigge H, Vorwerk R, et al.The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung injury.Anesth Analg, 2001, 92: 1226-1231.

1. ?ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al.Acute respiratory distress syndrome: the Berlin Definition.JAMA, 2012, 307: 2526-2533.
2. Diaz JV, Brower R, Calfee CS, et al.Therapeutic strategies for severe acute lung injury.Crit Care Med, 2010, 38: 1644-1650.
3. Gattinoni L, Taccone P, Carlesso E, et al.Prone position in acute respiratory distress syndrome.Rationale, indications, and limits.Am J Respir Crit Care Med, 2013, 188: 1286-1293.
4. Ball C, Adams J, Boyce S, et al.Clinical guidelines for the use of the prone position in acute respiratory distress syndrome.Intensive Crit Care Nurs, 2001, 17: 94-104.
5. 萬獻堯, 黃偉, 張久之,等.急性呼吸窘迫綜合征機械通氣患者院內死亡的危險因素分析.中國呼吸與危重監護雜志, 2006, 5: 4-6.
6. 宋鵬, 李琦, 王長征,等.17例重癥急性呼吸窘迫綜合征臨床資料回顧性分析.中國呼吸與危重監護雜志, 2006, 5: 35-38.
7. Sud S, Friedrich JO, Adhikari NK, et al.Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis.CMAJ, 2014, 186: E381-E390.
8. Hu SL, He HL, Pan C, et al.The effect of prone positioning on mortality in patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials.Crit Care, 2014, 18: R109.
9. 韓炳智, 韓韜, 吳志峰.重癥吸入性肺炎合并ARDS患者行俯臥位機械通氣時氧合、血流動力學及氣道引流的研究.中國呼吸與危重監護雜志, 2014, 13: 78-81.
10. 潘亮, 馬迎民, 劉又寧,等.采用壓力支持方式進行俯臥位通氣對急性呼吸窘迫綜合征的影響(附一例報告).中國呼吸與危重監護雜志, 2004, 3: 190-191.
11. Douglas WW, Rehder K, Froukje MB, et al.Improved oxygenation in patients with acute respiratory distress syndrome.Am Rev Respir Dis, 1974, 115: 559-566.
12. Jozwiak M, Teboul J L, Anguel N, et al.Beneficial hemodynamic effects of prone positioning in patients with acute respiratory distress syndrome.Am J Respir Crit Care Med, 2013, 188: 1428-1433.
13. Orchard CH, Sanchez de Leon R, Sykes MK.The relationship between hypoxic pulmonary vasoconstriction and arterial oxygen tension in the intact dog.J Physiol, 1983, 338: 61-74.
14. Vieillard-Baron A, Charron C, Caille V, et al.Prone positioning unloads the right ventricle in severe ARDS.Chest, 2007, 132: 1440-1446.
15. Kobirumaki-Shimozawa F, Inoue T, Shintani SA, et al.Cardiac thin filament regulation and the Frank-Starling mechanism.J Physiol Sci, 2014, 64: 221-232.
16. Hering R, Wrigge H, Vorwerk R, et al.The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung injury.Anesth Analg, 2001, 92: 1226-1231.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of Prone Position Ventilation on Hemodynamics in Patients with Interstitial Lung Disease Concurrent with Acute Respiratory Distress Syndrome

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