Абстрактный

Prone ventilation - It’s a challenge

Umesh Kumar Bylappa*, Khair Muhammad Burki, Ali Hiis Jillal, Roman Romulo S, Manrique JR, Albin Chacko

Prone Position ventilation (PP) has been used since the 1970s to treat severe hypoxemia in patients with ARDS/ALI because of its effectiveness at improving gas exchange. Meta-analyses have suggested better survival in patients with an arterial oxygen tension (PaO₂)/inspiratory oxygen fraction (FIO₂) ratio, 100 mmHg. A recent randomized controlled PROSEVA study trial was performed in ARDS patients in 2013 after a stabilization period of 12-24 h and severity criteria (PaO₂/FIO₂-150 mmHg at a positive end-expiratory pressure >5 cm H₂O). This randomized control study showed a significant reduction in mortality in prone group 32.8% versus in supine group 16% (P-0.001). The main goal of this article are to discuss about prone position ventilation which improves oxygenation in patients with ALI/ARDS; the evidence of its use based on trial analysis; and the limitations of its use as well as the current place of prone positioning in the management of patients with ALI/ARDS. Since 2013 after PROSEVA study trial proning has become more common in our ICUs. Although best clinical judgment to follow the PROSEVA trial’s protocol as a guideline are used and remains inconsistency in the timing and duration of proning in ARDS patients.