>Year 2017, Issue 4
Peniche MKG, Sánchez DJS, Castañeda VE, Calyeca SMV, Díaz GSP, Pin GE
Prone mechanical ventilation: ventilatory strategy early and prolonged in severe ARDS by influenzat
Rev Asoc Mex Med Crit y Ter Int 2017; 31 (4)
PDF: 208.74 Kb.
Background: Acute respiratory distress syndrome (ARDS) due to pulmonary disease is currently a condition that endangers the patient’s life, when severe and refractory hypoxemia develops, therapeutic strategies are limited and even controversial. Mechanical ventilation in prone position conducted early and prolonged is associated with increased survival.
Objetives: To determine the mortality associated with severe ARDS by influenza using a strategy of prolonged mechanical ventilation in prone position.
Materials and Methods: A prospective, cross-sectional, descriptive study intervention. March 2016 patients were recruited to April 2016 with the diagnosis of severe ARDS, which will enter the Intensive Care Unit (ICU). They were grouped patients according to outcome (improvement or death).
Results: Nine patients were included, with a mean age of 47 ± 16 years. 78% were men. The most frequent comorbidity was hypertension with 44%. During their stay, eight patients underwent mechanical ventilation in prone position and were grouped according to the outcome. Three patients died and six were discharged from the ICU for improvement. No significant difference was observed in age, duration, pH levels, PaO2, PaCO2, HCO3 or SOFA at admission in both groups (p › 0.05 in all cases). Ninety six hours after pronation values PEEP were higher in patients who died (p = 0.026) and parameters ABG decrease in O2 levels and PaO2/FiO2 was observed, in addition to increase in FiO2 requirements in the patient who died, were statistically significant (p ‹ 0.05). Other factors that were analyzed were history of hypertension, diabetes mellitus, smoking, time pronation, handling and use of steroid antibiotics prior to admission to the ICU. (Fisher exact test with p › 0.05 and no significant OR in all cases).
Conclusions: Refractory hypoxemia is the most important factor involved with mortality in patients with severe ARDS. Mechanical ventilation in the prone position early and prolonged by 48 hours should be considered a standard practice in this patient group.
||Ventilation prone, severe hypoxemia, refractory hypoxemia, ARDS.
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>Year 2017, Issue 4