TY - JOUR
T1 - Prone positioning improves oxygenation in adult burn patients with severe acute respiratory distress syndrome
AU - Hale, Diane F.
AU - Cannon, Jeremy W.
AU - Batchinsky, Andriy I.
AU - Cancio, Leopoldo C.
AU - Aden, James K.
AU - White, Christopher E.
AU - Renz, Evan M.
AU - Blackbourne, Lorne H.
AU - Chung, Kevin K.
PY - 2012/6
Y1 - 2012/6
N2 - BACKGROUND: Prone positioning (PP) improves oxygenation and may provide a benefit in patients with acute respiratory distress syndrome (ARDS). This approach adds significant challenges to patients in intensive care by limiting access to the endotracheal or tracheostomy tube and vascular access. PP also significantly complicates burn care by making skin protection and wound care more difficult. We hypothesize that PP improves oxygenation and can be performed safely in burn patients with ARDS. METHODS: PPwas implemented in a burn intensive care unit for 18 patientswith severe refractoryARDS. The characteristics of these patients were retrospectively reviewed to evaluate the impact of PP on Pao 2:FiO 2 ratio (PFR) during the first 48 hours of therapy. Each patient was considered his or her own control before initiation of PP, and trends in PFR were evaluated with one-way analysis of variance. Secondary measures of complications and mortality were also evaluated. RESULTS: Mean PFR before PP was 87 (±38) with a mean sequential organ failure assessment score of 11 (±4). PFR improved during 48 hours in 12 of 14 survivors (p < 0.05). Mean PFR was 133 (±77) immediately after PP, 165 (±118) at 6 hours, 170 (±115) at 12 hours, 214 (±126) at 24 hours, 236 (±137) at 36 hours, and 210 (±97) at 48 hours. At each measured time interval except the last, PFR significantly improved. There were no unintended extubations. Facial pressure ulcers developed in four patients (22%). Overall, 14 survived 48 hours (78%), 12 survived 28 days (67%), and six survived to hospital discharge (33%). CONCLUSIONS: PP improves oxygenation in burn patients with severe ARDS and was safely implemented in a burn intensive care unit. Mortality in this population remains high, warranting investigation into additional complementary rescue therapies.
AB - BACKGROUND: Prone positioning (PP) improves oxygenation and may provide a benefit in patients with acute respiratory distress syndrome (ARDS). This approach adds significant challenges to patients in intensive care by limiting access to the endotracheal or tracheostomy tube and vascular access. PP also significantly complicates burn care by making skin protection and wound care more difficult. We hypothesize that PP improves oxygenation and can be performed safely in burn patients with ARDS. METHODS: PPwas implemented in a burn intensive care unit for 18 patientswith severe refractoryARDS. The characteristics of these patients were retrospectively reviewed to evaluate the impact of PP on Pao 2:FiO 2 ratio (PFR) during the first 48 hours of therapy. Each patient was considered his or her own control before initiation of PP, and trends in PFR were evaluated with one-way analysis of variance. Secondary measures of complications and mortality were also evaluated. RESULTS: Mean PFR before PP was 87 (±38) with a mean sequential organ failure assessment score of 11 (±4). PFR improved during 48 hours in 12 of 14 survivors (p < 0.05). Mean PFR was 133 (±77) immediately after PP, 165 (±118) at 6 hours, 170 (±115) at 12 hours, 214 (±126) at 24 hours, 236 (±137) at 36 hours, and 210 (±97) at 48 hours. At each measured time interval except the last, PFR significantly improved. There were no unintended extubations. Facial pressure ulcers developed in four patients (22%). Overall, 14 survived 48 hours (78%), 12 survived 28 days (67%), and six survived to hospital discharge (33%). CONCLUSIONS: PP improves oxygenation in burn patients with severe ARDS and was safely implemented in a burn intensive care unit. Mortality in this population remains high, warranting investigation into additional complementary rescue therapies.
KW - ARDS
KW - Burn
KW - Hypoxemia
KW - Inhalation injury
KW - Prone positioning
UR - http://www.scopus.com/inward/record.url?scp=84864545323&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e318247cd4f
DO - 10.1097/TA.0b013e318247cd4f
M3 - Article
C2 - 22695433
AN - SCOPUS:84864545323
SN - 2163-0755
VL - 72
SP - 1634
EP - 1639
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 6
ER -