tailieunhanh - Báo cáo y học: "Prone position and recruitment manoeuvre: the combined effect improves oxygenation"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Prone position and recruitment manoeuvre: the combined effect improves oxygenation. | Rival et al. Critical Care 2011 15 R125 http content 15 3 R125 KS CRITICAL CARE RESEARCH Open Access Prone position and recruitment manoeuvre the combined effect improves oxygenation 1 2 3 2 2 24 Gilles Rival Cyrille Patry Nathalie Floret Jean Christophe Navellou Evelyne Belle and Gilles Capellier Abstract Introduction Among the various methods for improving oxygenation while decreasing the risk of ventilation-induced lung injury in patients with acute respiratory distress syndrome ARDS a ventilation strategy combining prone position PP and recruitment manoeuvres RMs can be practiced. We studied the effects on oxygenation of both RM and PP applied in early ARDS patients. Methods We conducted a prospective study. Sixteen consecutive patients with early ARDS fulfilling our criteria ratio of arterial oxygen partial pressure to fraction of inspired oxygen PaO2 FiO2 28 mmHg positive end expiratory pressure cmH2O were analysed. Each patient was ventilated in both the supine position SP and the PP six hours in each position . A 45 cmH2O extended sigh in pressure control mode was performed at the beginning of SP RM1 one hour after turning to the PP RM2 and at the end of the six-hour PP period RM3 . Results The mean arterial oxygen partial pressure PaO2 changes after RM1 RM2 and RM3 were 15 and 19 respectively. The PaO2 improvement after a single RM was significant after RM3 only P . Improvements in PaO2 level and PaO2 FiO2 ratio were transient in SP but durable during PP. PaO2 FiO2 ratio peaked at 218 mmHg after RM3. PaO2 FiO2 changes were significant only after RM3 and in the pulmonary ARDS group P . This global strategy had a benefit with regard to oxygenation PaO2 FiO2 ratio increased from mmHg to mmHg 13 hours later at the end of the study P . Plateau airway pressures decreased after each RM and over the entire PP period and significantly after RM3 P . Some reversible side effects such as significant blood .