Accession Number:

ADA629608

Title:

Prone Positioning Improves Oxygenation in Adult Burn Patients with Severe Acute Respiratory Distress Syndrome

Descriptive Note:

Journal article

Corporate Author:

ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX

Report Date:

2012-01-01

Pagination or Media Count:

7.0

Abstract:

BACKGROUND Prone positioning PP improves oxygenation and may provide a benefit in patients with acute respiratory distress syndrome ARDS. This approach adds significant challenges to patients in intensive care by limiting access to the endotracheal or tracheostomy tube and vascular access. PP also significantly complicates burn care by making skin protection and wound care more difficult. We hypothesize that PP improves oxygenation and can be performed safely in burn patients with ARDS. METHODS PP was implemented in a burn intensive care unit for 18 patients with severe refractory ARDS. The characteristics of these patients were retrospectively reviewed to evaluate the impact of PP on Pao2FiO2 ratio PFR during the first 48 hours of therapy. Each patient was considered his or her own control before initiation of PP, and trends in PFR were evaluated with one-way analysis of variance. Secondary measures of complications and mortality were also evaluated. RESULTS Mean PFR before PP was 87 or - 38 with a mean sequential organ failure assessment score of 11 or - 4. PFR improved during 48 hours in 12 of 14 survivors p less than 0.05. Mean PFR was 133 or - 77 immediately after PP, 165 or - 118 at 6 hours, 170 or - 115 at 12 hours, 214 or - 126 at 24 hours, 236 or - 137 at 36 hours, and 210 or - 97 at 48 hours. At each measured time interval except the last, PFR significantly improved. There were no unintended extubations. Facial pressure ulcers developed in four patients 22. Overall, 14 survived 48 hours 78, 12 survived 28 days 67, and six survived to hospital discharge 33. CONCLUSIONS PP improves oxygenation in burn patients with severe ARDS and was safely implemented in a burn intensive care unit. Mortality in this population remains high, warranting investigation into additional complementary rescue therapies.

Subject Categories:

  • Anatomy and Physiology
  • Medicine and Medical Research

Distribution Statement:

APPROVED FOR PUBLIC RELEASE