Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2020; 17 (4): 241-328 ➤ Влияние искусственной вентиляции легких в prone-position на оксигенацию и выживаемость при остром респираторном дистресс-синдроме и возможности применения у кардиохирургических больных

Effect of mechanical ventilation in the prone-position on oxygenation and survival in severe acute respiratory distress syndrome and the possibility of use in cardiac surgery patients

Authors: Leushin K.Yu

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2020-17-4-257-265

UDC: 616.24-008.4-085:615.816.2

Link: Clinical Physiology of Blood Circulaiton. 2020; 4 (17): 257-265

Quote as: : Leushin K.Yu. Effect of mechanical ventilation in the prone-position on oxygenation and survival in severe acute respiratory distress syndrome and the possibility of use in cardiac surgery patients. Clinical Physiology of Circulation. 2020; 17 (4): 257–65 (in Russ.). DOI: 10.24022/1814-6910-2020-17-4-257-265

Keywords:  acute respiratory distress syndrome computed tomography mechanical ventilation prone-position oxygenation survival cardiac surgery complications

Received / Accepted:  28.08.2020 / 06.09.2020

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Abstract

Acute respiratory distress syndrome (ARDS) is one of the main complications of various life-threatening conditions.

Mortality, depending on the cause of ARDS, the severity of its course and multiple organ failure, on average is about 35–45%. After heart surgery, ARDS develops in 0.4–20% of cases. Data on mortality in ARDS in cardiac surgery patients are contradictory and are in the range of 22–80%.

The pathophysiological rationale for using a ventilator in the abdominal position (prone-position) is that under the influence of gravity, due to decompression and opening of the collabated and atelectated alveoli of the dorsal, most affected partsof the lungs, there is an improvement in gas exchange and oxygenation of arterial blood. All researchers noted an increase in oxygenation in the majority of patients with ARDS. With ventilation in the prone-position for 17±3 hours, the mortality rate on day 28 was 16.0% and 32.8% in the supine-position group, on day 90, 23.6% vs 41.0%, respectively.

The use of a ventilator in the prone position in ARDS in cardiac surgery patients is limited in unstable hemodynamics, may be accompanied by bedsores and complications from a sternotomic wound, but at the same time, it is an effective method of increasing oxygenation in severe hypoxemia with a PaO2/FiO2 index < 150. Measures to prevent pressure sores of the face and the chest are mandatory.

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About Authors

Konstantin Yu. Leushin, Resuscitator; ORCID

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