Effects of prone position on inflammatory markers in patients with ARDS due to community-acquired pneumonia.
OBJECTIVE
Acute respiratory distress syndrome (ARDS) is a serious disorder of intensive care unit patients. We evaluated the safety of continuous prone position ventilation (PRONE) and its effects on oxygenation and plasma cytokine concentrations in patients with ARDS caused by severe community-acquired pneumonia (CAP).


METHODS
This was a prospective observational clinical study conducted in a respiratory intensive care unit of a 1200-bed medical center in central Taiwan. Twenty-two patients with severe CAP and ARDS were included. They were treated by traditional supine ventilation (SUPINE, n = 11) or PRONE (n = 11) if they met the criteria for ARDS. Patients in the PRONE group were ventilated in prone position continuously for at least 72 hours. Plasma cytokines were collected and analyzed at baseline, 24 hours and 72 hours after enrolment. Serial PaO2/FiO2 and complications were evaluated.


RESULTS
Complications associated with PRONE were minor and self-limited. PRONE had higher PaO2/FiO2 ratio than SUPINE did at 48 hours after enrolment. The levels of plasma IL-6 concentration declined significantly with time in the PRONE group (p = 0.011). The levels of plasma IL-6 concentration at enrolment, 24 hours and 72 hours after enrolment also predicted the 14th day mortality of all patients.


CONCLUSIONS
PRONE was a safe and effective maneuver for improving oxygenation in patients with severe CAP and ARDS. PRONE also influenced IL-6 expression in patients with severe CAP.
Chan
Ming-Cheng
MC
Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Hsu
Jeng-Yuan
JY
Liu
Hsiu-Hwa
HH
Lee
Yao-Ling
YL
Pong
Su-Chen
SC
Chang
Li-Yin
LY
Kuo
Benjamin Ing-Tiau
BI
Wu
Chieh-Liang
CL
D000368:Aged; D017714:Community-Acquired Infections / Q000150:complications*; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011014:Pneumonia / Q000150:complications*; D011175:Positive-Pressure Respiration; D016684:Prone Position; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy
D016207:Cytokines; D010100:Oxygen