Juan GMA, Garduño LJ, Amezcua GMA, Alva ANV, Zamora GSE, Gasca AJC

Language: Spanish
References: 13
Page: 486-489
PDF size: 250.92 Kb.

ABSTRACT

Introduction: the prone position is considered a fundamental maneuver within the treatment pillars in patients with acute respiratory distress syndrome (ARDS). However, the literature that mentions this maneuver does not consider the cerebral hemodynamic changes. The objective of this study was to evaluate the cerebral hemodynamic behavior after the change of position from supine to prone in patients with ARDS, whether of pulmonary or extrapulmonary origin, with or without acute traumatic injury. Objectives: to evaluate the alteration of cerebral hemodynamic behavior after changing the prone position. Material and methods: a descriptive, observational, prospective study was conducted in a cohort of twenty-six patients admitted to an adult intensive care unit of a third-level hospital over a seven-month period. Patients diagnosed with ARDS who required prone positioning, who had an adequate transtemporal window for evaluation of cerebral hemodynamics by transcranial Doppler ultrasound through the middle cerebral artery, and who gave their informed consent were included. Results: measurements were obtained from twenty-six patients with a diagnosis of ARDS who required prone position. The Kolmogorov-Smirnov test was applied, showing normality of the sample, fifteen were men (57.7%) and eleven were women (42.3%). The admission diagnoses were three neurocritical patients plus ARDS (11.5%) and twenty-three had ARDS only (88.5%). Using the repeated means ANOVA test, statistical significance was shown during the measurements made before and during the prone position, but with stability after the first hour of the prone position, remaining within physiological ranges. An increase in the left and right middle cerebral artery (MCA) flows of the systolic velocity (SV), diastolic velocity (DV) and mean velocity (MV) was evident after performing the prone position (p < 0.001), as well as an increase in pulsatility index (PI), resistive index (RI) and cerebral perfusion pressure (CPP) (p < 0.005); however, they remained stable towards the first hour of the maneuver. In the case of intracranial pressure (ICP), a decrease of up to 1.1 mmHg (p < 0.005) was observed during the prone position. Conclusions: it was determined that during the prone position in patients with ARDS, changes in cerebral hemodynamics occurred, measured by transcranial Doppler at the patient's bedside, although these changes remained within physiological ranges. Regarding ICP, it was shown that after the prone position, there was even a decrease of up to 1.1 mmHg, so we could consider that the prone position is safe and beneficial for patients with ARDS.

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