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DOI: 10.1055/s-0038-1627979
Prone Positioning Is a Safe and Effective Method in the Management of Acute Lung Injury after Cardiac Surgery
Publication History
Publication Date:
22 January 2018 (online)
Objectives: The aim of the study was to determine the benefit of prone positioning in patients developing acute lung injury (ALI) following cardiac surgery.
Methods: A review of 438 consecutive patients who underwent cardiac surgery at our institution from October 2016 to May 2017 revealed 14 patients who underwent prone positioning (PP) for the treatment of ALI. We excluded 3 patients who underwent simultaneous ECMO therapy. Data collection included the Horowitz index (HI) and peak inspiratory pressure (PIP) at the time of PP, 6 hours after PP, at the end of PP and 6 hours after return to supine position (SP). Results are presented as medians with interquartile ranges.
Results: The median EuroSCORE II was 3.1% (1.3–7.9). Three patients had a history of COPD and two were diagnosed with pulmonary hypertension. Five patients underwent emergency surgery. The median duration of postoperative mechanical ventilation was 285 hours (179–535), 6 patients suffered from nosocomial pneumonia. The median duration of PP was 12 hours (12–12) and the median number of days after surgery where PP was implemented was 2 (0–9). We observed an increase in HI at the end of PP as compared with before PP (90 (73–123) vs 198 (101–243), p = 0.004). This was followed by an insignificant decline in HI 6 hours after return to SP (168 (131–253), p = 0.657). In sum, the overall increase in HI compared with baseline values and values at 6 hours after return to SP indicated a significant respiratory improvement (90 (73–123) vs 168 (131–253), p = 0.006). Accordingly, we observed a significant decrease in PIP at the beginning of PP and 6 hours after return to SP (26 cm H2O (20–28) vs 22 cm H2O (21–28), p = 0.05). A total of 4 patients underwent percutaneous dilative tracheostomy after PP. The median duration of ICU stay was 15 days (12–19). There were no adverse events reported during the positioning of the patients. 8 patients survived to discharge.
Conclusion: Prone positioning is a safe and effective treatment for ALI after cardiac surgery improving short and medium term respiratory condition.