Prone positioning and acute respiratory distress syndrome after cardiac surgery: a feasibility study.
OBJECTIVE
To determine the feasibility, safety, and efficacy on PaO(2)/F(I)O(2) ratio of prone positioning (PP) for acute respiratory distress syndrome (ARDS) after cardiac surgery.


METHODS
Retrospective review of information entered prospectively in the authors' database.


METHODS
A private community nonteaching hospital.


METHODS
Sixteen patients who developed ARDS after cardiac surgery from January 2004 through June 2005.


METHODS
PP to improve oxygenation.


RESULTS
After a median duration of 18 (range, 14-27) hours in PP, PaO(2)/F(I)O(2) improved in 14 (87.5%) patients. For the entire population, median PaO(2)/F(I)O(2) rose from 87 (range, 56-161) before PP to 194 (range, 94-460; p < 0.05) after it. After supine repositioning (SR), PaO(2)/F(I)O(2) declined to 146 (range, 72-320; not significant). PaO(2)/F(I)O(2) at the end of PP and 1 day after SR were comparable, respectively, 194 (range, 94-460) and 184 (range, 105-342). No severe complication was associated with PP, but 5 patients developed pressure sores and 2 others had superficial sternal wound infections. Intensive care unit mortality of 37.5% reflected the number of organ failure(s); there were no deaths with 2 failures, and 60% with > or = 3 organ failures died (p = 0.03). Mortality rates were comparable regardless of whether patients were PaO(2)/F(I)O(2) responders or their PaCO(2) decreased by > or = 1 mmHg.


CONCLUSIONS
PP to treat ARDS after cardiac surgery is feasible, safe, and can efficiently improve oxygenation. Measures to prevent pressure sores are mandatory.
Maillet
Jean-Michel
JM
Cardiovascular and Thoracic Surgery Intensive Care Unit, Centre Cardiologique du Nord, Saint-Denis Cedex, France. jm.maillet@ccncardio.com
Thierry
Stéphane
S
Brodaty
Denis
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016684:Prone Position / Q000502:physiology*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control*; D012189:Retrospective Studies