ÖZET
Amaç:
Pandemi sürecinde koronavirus hastalığı-2019’a bağlı akut respiratuvar distres sendromu (C-ARDS) yoğunluğunun artması ile yüzüstü pozisyonun önemi artmıştır. C-ARDS hastalarında uzamış yüzüstü pozisyon sürelerinin hasta sırtüstü pozisyona çevrildikten sonra (post-yüzüstü etki) kan gazı parametreleri üzerine etkisinin, uzamış yüzüstü uygulamasının uygulanabilirliğinin, güvenliğinin ve 28 günlük mortalite üzerine etkisinin araştırılması amaçlanmıştır.
Gereç ve Yöntem:
Bu çalışma, 432’si yoğun bakım ünitesi olmak üzere toplam 1000 yataklı, tek merkezli, prospektif, gözlemsel bir çalışmadır. Şiddetli ve orta ARDS; standart yüzüstü (16 saat) ve uzatılmış yüzüstü (36 saat) pozisyonu uygulanan hastaların kan gazı parametreleri (PaO2/FiO2, PaO2, SpO2 vb.) karşılaştırıldı.
Bulgular:
Uzamış yüzüstü grubunda yüzüstü sonrası sırtüstü pozisyona alınarak 8. saatte (t4) (postyüzüstü) bakılan PaO2/FiO2, PaO2 ve SpO2 değerlerinin yüzüstü öncesine (t1) göre yüksek olduğu gözlenmiştir (p<0,001). Standart yüzüstü grubunda ise PaO2/FiO2 PaO2 ve SpO2 değerlerinin postyüzüstü dönemde korunmadığı hatta yüzüstü öncesine göre daha düşük olduğu görülmüştür. Standart yüzüstü grubundaki hastaların mortalitesi %51,7 (n=31); uzamış yüzüstü grubunda ise mortalite %45’dir (n=27).
Sonuç:
Uzamış yüzüstü pozisyonu uygulaması ile C-ARDS hastalarında daha az iş gücüyle hastalara zarar vermeden (bası yarası, retina hasarı, eklem hasarı vb.) daha iyi kan gazı değişimi olduğu görülmüştür.
References
1
Chang R, Elhusseiny KM, Yeh YC, Sun WZ. COVID-19 ICU and mechanical ventilation patient characteristics and outcomes-A systematic review and meta-analysis. PLoS One 2021;16:e0246318.
2
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med 2020;180:934-43. Erratum in: JAMA Intern Med 2020;180:1031.
3
Walter T, Zucman N, Mullaert J, Thiry I, Gernez C, Roux D, et al. Extended prone positioning duration for COVID-19-related ARDS: benefits and detriments. Crit Care 2022;26:208.
4
Bloomfield R, Noble DW, Sudlow A. Prone position for acute respiratory failure in adults. Cochrane Database Syst Rev 2015;2015:CD008095.
5
Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med 2020;48:e440-69.
6
Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, et al. (2017) Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2017;14:S280-8.
7
Carsetti A, Damia Paciarini A, Marini B, Pantanetti S, Adrario E, et al. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective. Crit Care 2020;24:225.
8
Petrone P, Brathwaite CEM, Joseph DK. Prone ventilation as treatment of acute respiratory distress syndrome related to COVID-19. Eur J Trauma Emerg Surg 2021;47:1017-22.
9
Spinelli E, Kircher M, Stender B, Ottaviani I, Basile MC, Marongiu I, et al. Unmatched ventilation and perfusion measured by electrical impedance tomography predicts the outcome of ARDS. Crit Care 2021;25:192.
10
Rasch S, Schmidle P, Sancak S, Herner A, Huberle C, Schulz D, et al. Increased extravascular lung water index (EVLWI) reflects rapid non-cardiogenic oedema and mortality in COVID-19 associated ARDS. Sci Rep 2021;11:11524.
11
Shi R, Lai C, Teboul JL, Dres M, Moretto F, De Vita N, et al COVID-19 ARDS is characterized by higher extravascular lung water than non-COVID-19 ARDS: the PiCCOVID study. Crit Care 2021;25:186.
12
Mora-Arteaga JA, Bernal-Ramírez OJ, Rodríguez SJ. The effects of prone position ventilation in patients with acute respiratory distress syndrome. A systematic review and metaanalysis. Med Intensiva 2015;39:359-72.
13
ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-33.
14
Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: diagnosis and management. Am Fam Physician 2013;88:102-10.
15
Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System. J Wound Ostomy Continence Nurs 2016;43:585-97.
16
Langer T, Brioni M, Guzzardella A, Carlesso E, Cabrini L, Castelli G, et al. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Crit Care 2021;25:128.
17
Fossali T, Pavlovsky B, Ottolina D, Colombo R, Basile MC, Castelli A, et al. Effects of Prone Position on Lung Recruitment and Ventilation-Perfusion Matching in Patients With COVID-19 Acute Respiratory Distress Syndrome: A Combined CT Scan/Electrical Impedance Tomography Study. Crit Care Med 2022;50:723-32.
18
Oczenski W, Hörmann C, Keller C, Lorenzl N, Kepka A, Schwarz S, et al. Recruitment maneuvers during prone positioning in patients with acute respiratory distress syndrome. Crit Care Med 2005;33:54-61.
19
Gattinoni L, Taccone P, Carlesso E, Marini JJ. Prone position in acute respiratory distress syndrome. Rationale, indications, and limits. Am J Respir Crit Care Med 2013;188:1286-93.
20
Behesht Aeen F, Pakzad R, Goudarzi Rad M, Abdi F, Zaheri F, Mirzadeh N. Effect of prone position on respiratory parameters, intubation and death rate in COVID-19 patients: systematic review and meta-analysis. Sci Rep 2021;11:14407.
21
Gattinoni L, Vagginelli F, Carlesso E, Taccone P, Conte V, Chiumello D, et al. Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med 2003;31:2727-33.
22
Douglas IS, Rosenthal CA, Swanson DD, Hiller T, Oakes J, Bach J, et al. Safety and Outcomes of Prolonged Usual Care Prone Position Mechanical Ventilation to Treat Acute Coronavirus Disease 2019 Hypoxemic Respiratory Failure. Crit Care Med 2021;49:490-502.
23
Concha P, Treso-Geira M, Esteve-Sala C, Prades-Berengué C, Domingo-Marco J, Roche-Campo F. Invasive mechanical ventilation and prolonged prone position during the COVID-19 pandemic. Med Intensiva 2021;46:161-3.
24
Page DB, Vijaykumar K, Russell DW, Gandotra S, Chiles JW, Whitson MR, et al. Prolonged Prone Positioning for COVID-19-induced Acute Respiratory Distress Syndrome: A Randomized Pilot Clinical Trial. Ann Am Thorac Soc 2022;19:685-7.
25
Rezoagli E, Mariani I, Rona R, Foti G, Bellani G. Difference between prolonged versus standard duration of prone position in COVID-19 patients: a retrospective study. Minerva Anestesiol 2021;87:1383-5.
26
Lucchini A, Bambi S, Mattiussi E, Elli S, Villa L, Bondi H, et al. Prone Position in Acute Respiratory Distress Syndrome Patients: A Retrospective Analysis of Complications. Dimens Crit Care Nurs 2020;39:39-46.
27
Girard R, Baboi L, Ayzac L, Richard JC, Guérin C; Proseva trial group. The impact of patient positioning on pressure ulcers in patients with severe ARDS: results from a multicentre randomised controlled trial on prone positioning. Intensive Care Med 2014;40:397-403.
28
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;28;395:1054-62.
29
Tu Y, Yang P, Zhou Y, Wen X, Li Q, Zhou J, et al. Risk factors for mortality of critically ill patients with COVID-19 receiving invasive ventilation. Int J Med Sci 2021;18:1198-206.
