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Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome.
Crit Care Med. 2003 Dec; 31(12):2727-33.CC

Abstract

OBJECTIVE

To determine whether gas exchange improvement in response to the prone position is associated with an improved outcome in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).

DESIGN

Retrospective analysis of patients in the pronation arm of a controlled randomized trial on prone positioning and patients enrolled in a previous pilot study of the prone position.

SETTING

Twenty-eight Italian and two Swiss intensive care units.

PATIENTS

We studied 225 patients meeting the criteria for ALI or ARDS.

INTERVENTIONS

Patients were in prone position for 10 days for 6 hrs/day if they met ALI/ARDS criteria when assessed each morning. Respiratory variables were recorded before and after 6 hrs of pronation with unchanged ventilatory settings.

MEASUREMENTS AND MAIN RESULTS

We measured arterial blood gas alterations to the first pronation and the 28-day mortality rate. The independent risk factors for death in the general population were the Pao2/Fio2 ratio (odds ratio, 0.992; confidence interval, 0.986-0.998), the minute ventilation/Paco2 ratio (odds ratio, 1.003; confidence interval, 1.000-1.006), and the concentration of plasma creatinine (odds ratio, 1.385; confidence interval, 1.116-1.720). Pao2 responders (defined as the patients who increased their Pao2/Fio2 by > or =20 mm Hg, 150 patients, mean increase of 100.6 +/- 61.6 mm Hg [13.4 +/- 8.2 kPa]) had an outcome similar to the nonresponders (59 patients, mean decrease -6.3 +/- 23.7 mm Hg [-0.8 +/- 3.2 kPa]; mortality rate 44% and 46%, respectively; relative risk, 1.04; confidence interval, 0.74-1.45, p =.65). The Paco2 responders (defined as patients whose Paco2 decreased by > or =1 mm Hg, 94 patients, mean decrease -6.0 +/- 6 mm Hg [-0.8 +/- 0.8 kPa]) had an improved survival when compared with nonresponders (115 patients, mean increase 6 +/- 6 mm Hg [0.8 +/- 0.8 kPa]; mortality rate 35.1% and 52.2%, respectively; relative risk, 1.48; confidence interval, 1.07-2.05, p =.01).

CONCLUSION

ALI/ARDS patients who respond to prone positioning with reduction of their Paco2 show an increased survival at 28 days. Improved efficiency of alveolar ventilation (decreased physiologic deadspace ratio) is an important marker of patients who will survive acute respiratory failure.

Authors+Show Affiliations

Istituto di Anestesia e Rianimazione, Universitá degli Studi di Milano, Ospedale Policlinico, Milan, Italy. gattinon@policlinico.mi.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14668608

Citation

Gattinoni, Luciano, et al. "Decrease in PaCO2 With Prone Position Is Predictive of Improved Outcome in Acute Respiratory Distress Syndrome." Critical Care Medicine, vol. 31, no. 12, 2003, pp. 2727-33.
Gattinoni L, Vagginelli F, Carlesso E, et al. Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med. 2003;31(12):2727-33.
Gattinoni, L., Vagginelli, F., Carlesso, E., Taccone, P., Conte, V., Chiumello, D., Valenza, F., Caironi, P., & Pesenti, A. (2003). Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. Critical Care Medicine, 31(12), 2727-33.
Gattinoni L, et al. Decrease in PaCO2 With Prone Position Is Predictive of Improved Outcome in Acute Respiratory Distress Syndrome. Crit Care Med. 2003;31(12):2727-33. PubMed PMID: 14668608.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decrease in PaCO2 with prone position is predictive of improved outcome in acute respiratory distress syndrome. AU - Gattinoni,Luciano, AU - Vagginelli,Federica, AU - Carlesso,Eleonora, AU - Taccone,Paolo, AU - Conte,Valeria, AU - Chiumello,Davide, AU - Valenza,Franco, AU - Caironi,Pietro, AU - Pesenti,Antonio, AU - ,, PY - 2003/12/12/pubmed PY - 2004/1/17/medline PY - 2003/12/12/entrez SP - 2727 EP - 33 JF - Critical care medicine JO - Crit Care Med VL - 31 IS - 12 N2 - OBJECTIVE: To determine whether gas exchange improvement in response to the prone position is associated with an improved outcome in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). DESIGN: Retrospective analysis of patients in the pronation arm of a controlled randomized trial on prone positioning and patients enrolled in a previous pilot study of the prone position. SETTING: Twenty-eight Italian and two Swiss intensive care units. PATIENTS: We studied 225 patients meeting the criteria for ALI or ARDS. INTERVENTIONS: Patients were in prone position for 10 days for 6 hrs/day if they met ALI/ARDS criteria when assessed each morning. Respiratory variables were recorded before and after 6 hrs of pronation with unchanged ventilatory settings. MEASUREMENTS AND MAIN RESULTS: We measured arterial blood gas alterations to the first pronation and the 28-day mortality rate. The independent risk factors for death in the general population were the Pao2/Fio2 ratio (odds ratio, 0.992; confidence interval, 0.986-0.998), the minute ventilation/Paco2 ratio (odds ratio, 1.003; confidence interval, 1.000-1.006), and the concentration of plasma creatinine (odds ratio, 1.385; confidence interval, 1.116-1.720). Pao2 responders (defined as the patients who increased their Pao2/Fio2 by > or =20 mm Hg, 150 patients, mean increase of 100.6 +/- 61.6 mm Hg [13.4 +/- 8.2 kPa]) had an outcome similar to the nonresponders (59 patients, mean decrease -6.3 +/- 23.7 mm Hg [-0.8 +/- 3.2 kPa]; mortality rate 44% and 46%, respectively; relative risk, 1.04; confidence interval, 0.74-1.45, p =.65). The Paco2 responders (defined as patients whose Paco2 decreased by > or =1 mm Hg, 94 patients, mean decrease -6.0 +/- 6 mm Hg [-0.8 +/- 0.8 kPa]) had an improved survival when compared with nonresponders (115 patients, mean increase 6 +/- 6 mm Hg [0.8 +/- 0.8 kPa]; mortality rate 35.1% and 52.2%, respectively; relative risk, 1.48; confidence interval, 1.07-2.05, p =.01). CONCLUSION: ALI/ARDS patients who respond to prone positioning with reduction of their Paco2 show an increased survival at 28 days. Improved efficiency of alveolar ventilation (decreased physiologic deadspace ratio) is an important marker of patients who will survive acute respiratory failure. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/14668608/Decrease_in_PaCO2_with_prone_position_is_predictive_of_improved_outcome_in_acute_respiratory_distress_syndrome_ L2 - https://dx.doi.org/10.1097/01.CCM.0000098032.34052.F9 DB - PRIME DP - Unbound Medicine ER -