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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 the same patient at the end of prone ventilation on 6th day
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Figure 3: Chest X-ray of the same patient at the end of prone ventilation on 6th day

Mentions: The ICU mortality of H1N1 patients with severe ARDS is about 10-38% and increases up to 58% in patients requiring invasive mechanical ventilation.[16] Sahoo et al.[17] in their study shown that out of seven patients, five patients had MODS. The commonest organ involved was renal. In our study acute kidney injury was seen in two patients but recovered without any need of dialysis. Ventilator associated pneumonia was seen in two patients (acenetobacter was found in both patients), myocarditis in two patients, critical illness myopathy and atrial fibrillation in one patient each. None of our patients had pneumothorax (probably due to maintenance of lower tidal volume and lesser PEEP). Figure 3 showing chest X-ray of the same patient at the end of prone ventilation on 6th day.


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 the same patient at the end of prone ventilation on 6th day
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Chest X-ray of the same patient at the end of prone ventilation on 6th day
Mentions: The ICU mortality of H1N1 patients with severe ARDS is about 10-38% and increases up to 58% in patients requiring invasive mechanical ventilation.[16] Sahoo et al.[17] in their study shown that out of seven patients, five patients had MODS. The commonest organ involved was renal. In our study acute kidney injury was seen in two patients but recovered without any need of dialysis. Ventilator associated pneumonia was seen in two patients (acenetobacter was found in both patients), myocarditis in two patients, critical illness myopathy and atrial fibrillation in one patient each. None of our patients had pneumothorax (probably due to maintenance of lower tidal volume and lesser PEEP). Figure 3 showing chest X-ray of the same patient at the end of prone ventilation on 6th day.

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