[Results of the treatment of cardiac surgery patients with postoperative acute respiratory distress syndrome by prone-position pulmonary ventilation].
Prone position ventilation (PPV) became an effective method of management of ARDS since 1974. Its positive effects on arterial oxygenation have been amply described, but its impact on the results of treatment and hospital mortality remains a disputable point. We observed 2 groups of patients, 36 pts. each, with ARDS after cardiovascular surgery. The main causes of ARDS were shock syndrome, massive blood loss and transfusion, previous COPD, and postcardiopulmonary bypass ALI. Because of impaired lung function (PaO2/FiO2 < 200), all patients were supported by special methods of ventilation including PEEP, high FiO2, and PCV with inverse I:E ratio. In the main group, PPV was started on days 3.6 +/- 1.2 postoperation. Daily duration of PPV was 4-12 h, after which the patients were turned into a supine position. Controls were treated in a supine position. The groups were identical by age, sex, types of surgery, severity of ARF, and manifestations of MOSF. PPV improved lung function and arterial oxygenation. Clinical outcomes were better in the PPV group than in the controls: a lower frequency of threatening arrhythmia, better results of MOSF treatment, and lower mortality (69 and 33.4%, respectively). Prone position is an effective measure improving arterial oxygenation in patients with ARDS after cardiovascular surgery. The main results of PPV are decrease in complications induced by hypoxia and higher survival rate.
Eremenko
A A
AA
Egorov
V M
VM
Levikov
D I
DI
D000208:Acute Disease; D002245:Carbon Dioxide / Q000097:blood; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000628:therapy*; D016684:Prone Position; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012129:Respiratory Function Tests; D013997:Time Factors
D002245:Carbon Dioxide; D010100:Oxygen
Rezul'taty lecheniia kardiokhirurgicheskikh bol'nykh s posleoperatsionnym ostrym respiratornym distress-sindromom s ispol'zovaniem IVL v polozhenii na zhivote.