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Early reapplication of prone position during venovenous ECMO for acute respiratory distress syndrome: a prospective observational study and propensity-matched analysis.
- Source :
-
Annals of Intensive Care . 8/20/2024, Vol. 14 Issue 1, p1-13. 13p. - Publication Year :
- 2024
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Abstract
- Background: A combination of prone positioning (PP) and venovenous extracorporeal membrane oxygenation (VV-ECMO) is safe, feasible, and associated with potentially improved survival for severe acute respiratory distress syndrome (ARDS). However, whether ARDS patients, especially non-COVID-19 patients, placed in PP before VV-ECMO should continue PP after a VV-ECMO connection is unknown. This study aimed to test the hypothesis that early use of PP during VV-ECMO could increase the proportion of patients successfully weaned from ECMO support in severe ARDS patients who received PP before ECMO. Methods: In this prospective observational study, patients with severe ARDS who were treated with VV-ECMO were divided into two groups: the prone group and the supine group, based on whether early PP was combined with VV-ECMO. The proportion of patients successfully weaned from VV-ECMO and 60-day mortality were analyzed before and after propensity score matching. Results: A total of 165 patients were enrolled, 50 in the prone and 115 in the supine group. Thirty-two (64%) and 61 (53%) patients were successfully weaned from ECMO in the prone and the supine groups, respectively. The proportion of patients successfully weaned from VV-ECMO in the prone group tended to be higher, albeit not statistically significant. During PP, there was a significant increase in partial pressure of arterial oxygen (PaO2) without a change in ventilator or ECMO settings. Tidal impedance shifted significantly to the dorsal region, and lung ultrasound scores significantly decreased in the anterior and posterior regions. Forty-five propensity score-matched patients were included in each group. In this matched sample, the prone group had a higher proportion of patients successfully weaned from VV-ECMO (64.4% vs. 42.2%; P = 0.035) and lower 60-day mortality (37.8% vs. 60.0%; P = 0.035). Conclusions: Patients with severe ARDS placed in PP before VV-ECMO should continue PP after VV-ECMO support. This approach could increase the probability of successful weaning from VV-ECMO. Trial Registration: ClinicalTrials.Gov: NCT04139733. Registered 23 October 2019. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ADULT respiratory distress syndrome treatment
*REPEATED measures design
*EXTRACORPOREAL membrane oxygenation
*PATIENT safety
*ADULT respiratory distress syndrome
*EARLY medical intervention
*RESEARCH funding
*T-test (Statistics)
*SURVIVAL rate
*LYING down position
*SCIENTIFIC observation
*PROBABILITY theory
*PAIRED comparisons (Mathematics)
*FISHER exact test
*LOGISTIC regression analysis
*CLINICAL trials
*DESCRIPTIVE statistics
*LUNGS
*MANN Whitney U Test
*CHI-squared test
*LONGITUDINAL method
*CONTROL groups
*PRE-tests & post-tests
*KAPLAN-Meier estimator
*LOG-rank test
*STATISTICS
*VENTILATOR weaning
*PATIENT monitoring
*COMPARATIVE studies
*DATA analysis software
*COVID-19 pandemic
*PARTIAL pressure
*RESPIRATORY mechanics
*NONPARAMETRIC statistics
Subjects
Details
- Language :
- English
- ISSN :
- 21105820
- Volume :
- 14
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- Annals of Intensive Care
- Publication Type :
- Academic Journal
- Accession number :
- 179142223
- Full Text :
- https://doi.org/10.1186/s13613-024-01365-4