Limits...
Prone position and pressure control inverse ratio ventilation in H1N1 patients with severe acute respiratory distress syndrome.

Venkategowda PM, Rao SM, Harde YR, Raut MK, Mutkule DP, Munta K, Rao MV - Indian J Crit Care Med (2016)

Bottom Line: To observe the 28 and 90 days mortality associated with prone position and assist control-pressure control (with inverse ratio) ventilation (ACPC-IRV).The ICU length of stay was 11.16 days.There was no mortality at 28 and 90 days.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Yashoda Multi-speciality Hospital, Somajiguda, Hyderabad, Telangana, India.

ABSTRACT

Aim: To observe the 28 and 90 days mortality associated with prone position and assist control-pressure control (with inverse ratio) ventilation (ACPC-IRV).

Materials and methods: All patients who were admitted to our medical Intensive Care Unit (ICU) who are positive for H1N1 viral infection with severe acute respiratory distress syndrome (ARDS) and requiring invasive mechanical ventilation in prone position were included in our prospective observational study. Six patients who are positive for H1N1 required invasive ventilation in prone position. These patients were planned to ventilate in prone for 16 h and in supine for 8 h daily until P/F ratio >150 with FiO2 of 0.6 or less and positive end-expiratory pressure <10 cm of H2 O.

Results: At admission, among these six patients the mean tidal volume generated was about 376.6 ml which was in the range of 6-8 ml/kg predicted body weight. The mean lung injury score was 3.79, mean PaO2 /FiO2 ratio was 52.66 and mean oxygenation index was 29.83. The mean duration of ventilation was 9.4 days (225.6 h). The ICU length of stay was 11.16 days. There was no mortality at 28 and 90 days.

Conclusion: Early prone combined with ACPC-IRV in H1N1 patients having severe ARDS can be used as a rescue therapy and it should be confirmed by large observational studies.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray of our first patient having severe acute respiratory distress syndrome due to H1N1 infection
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4759994&req=5

Figure 1: Chest X-ray of our first patient having severe acute respiratory distress syndrome due to H1N1 infection

Mentions: The ventilator setting at the initiation of ventilation has been showed in Table 3. All six patients were intubated and connected to the ACPC-IRV. The mean tidal volume generated was about 376.6 ml which was in the range of 6–8 ml/kg predicted body weight at the beginning. The Inspiratory: Expiratory (I: E) ratio was initially kept 1:1 and later modified according to the PaO2 values (maximum was 2:1). The mean inspiratory pressure (Pi) was 20.66 cm H2 O, which was kept to achieve a tidal volume of 6–8 ml/kg predicted body weight and later reduced to about 6 ml/kg predicted body weight. The PEEP of 14 cm H2 O was kept initially and later reduced based on oxygenation parameter (never used more than 14 PEEP). The mean frequency and fraction of inspired oxygen were 31 breaths/min and 0.96 respectively. Figure 1 showing patient being ventilated in prone position.


Prone position and pressure control inverse ratio ventilation in H1N1 patients with severe acute respiratory distress syndrome.

Venkategowda PM, Rao SM, Harde YR, Raut MK, Mutkule DP, Munta K, Rao MV - Indian J Crit Care Med (2016)

Chest X-ray of our first patient having severe acute respiratory distress syndrome due to H1N1 infection
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4759994&req=5

Figure 1: Chest X-ray of our first patient having severe acute respiratory distress syndrome due to H1N1 infection
Mentions: The ventilator setting at the initiation of ventilation has been showed in Table 3. All six patients were intubated and connected to the ACPC-IRV. The mean tidal volume generated was about 376.6 ml which was in the range of 6–8 ml/kg predicted body weight at the beginning. The Inspiratory: Expiratory (I: E) ratio was initially kept 1:1 and later modified according to the PaO2 values (maximum was 2:1). The mean inspiratory pressure (Pi) was 20.66 cm H2 O, which was kept to achieve a tidal volume of 6–8 ml/kg predicted body weight and later reduced to about 6 ml/kg predicted body weight. The PEEP of 14 cm H2 O was kept initially and later reduced based on oxygenation parameter (never used more than 14 PEEP). The mean frequency and fraction of inspired oxygen were 31 breaths/min and 0.96 respectively. Figure 1 showing patient being ventilated in prone position.

Bottom Line: To observe the 28 and 90 days mortality associated with prone position and assist control-pressure control (with inverse ratio) ventilation (ACPC-IRV).The ICU length of stay was 11.16 days.There was no mortality at 28 and 90 days.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Yashoda Multi-speciality Hospital, Somajiguda, Hyderabad, Telangana, India.

ABSTRACT

Aim: To observe the 28 and 90 days mortality associated with prone position and assist control-pressure control (with inverse ratio) ventilation (ACPC-IRV).

Materials and methods: All patients who were admitted to our medical Intensive Care Unit (ICU) who are positive for H1N1 viral infection with severe acute respiratory distress syndrome (ARDS) and requiring invasive mechanical ventilation in prone position were included in our prospective observational study. Six patients who are positive for H1N1 required invasive ventilation in prone position. These patients were planned to ventilate in prone for 16 h and in supine for 8 h daily until P/F ratio >150 with FiO2 of 0.6 or less and positive end-expiratory pressure <10 cm of H2 O.

Results: At admission, among these six patients the mean tidal volume generated was about 376.6 ml which was in the range of 6-8 ml/kg predicted body weight. The mean lung injury score was 3.79, mean PaO2 /FiO2 ratio was 52.66 and mean oxygenation index was 29.83. The mean duration of ventilation was 9.4 days (225.6 h). The ICU length of stay was 11.16 days. There was no mortality at 28 and 90 days.

Conclusion: Early prone combined with ACPC-IRV in H1N1 patients having severe ARDS can be used as a rescue therapy and it should be confirmed by large observational studies.

No MeSH data available.


Related in: MedlinePlus