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Duration of prone position sessions: a prospective cohort study.

ABSTRACT: BACKGROUND:Prone position (PP) is highly recommended in moderate-to-severe ARDS. However, the optimal duration of PP sessions remains unclear. We searched to evaluate the time required to obtain the maximum physiological effect, and to search for parameters related to patient survival in PP. METHODS AND RESULTS:It was a prospective, monocentric, physiological study. We included in the study all prone-positioned patients in our ICU between June 2016 and January 2018. Pulmonary mechanics, data from volumetric capnography and arterial blood gas were recorded before prone positioning, 2 h after proning, before return to a supine position (SP) and 2 h after return to SP. Dynamic parameters were recorded before proning and every 30 min during the session until 24 h. 103 patients (ARDS 95%) were included performing 231 PP sessions with a mean length of 21.5?±?5 h per session. They presented a significant increase in pH, static compliance and PaO2/FiO2 with a significant decrease in PaCO2, Pplat, phase 3 slope of the volumetric capnography, PetCO2, VD/VT-phy and ?P. The beneficial physiological effects continued after 16 h of PP and at least up to 24 h in some patients. The evolution of the respiratory parameters during the first session and also during the pooled sessions did not find any predictor of response to PP, whether before, during or 2 h after the return in SP. CONCLUSIONS:PP sessions should be prolonged at least 24 h and be extended in the event that the PaO2/FiO2 ratio at 24 h remains below 150, especially since no criteria can predict which patient will benefit or not from it. Trial registration The trial has been registered on 28 June 2016 in ClinicalTrials.gov (NCT02816190) (https://clinicaltrials.gov/ct2/show/NCT02816190?term=propocap&rank=1).

SUBMITTER: Jochmans S

PROVIDER: S-EPMC7245995 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Duration of prone position sessions: a prospective cohort study.

Jochmans Sebastien S Mazerand Sandie S Chelly Jonathan J Pourcine Franck F Sy Oumar O Thieulot-Rolin Nathalie N Ellrodt Olivier O Mercier Des Rochettes Emmanuelle E Michaud Gaël G Serbource-Goguel Jean J Vinsonneau Christophe C Vong Ly Van Phach LVP Monchi Mehran M

Annals of intensive care 20200524 1

<h4>Background</h4>Prone position (PP) is highly recommended in moderate-to-severe ARDS. However, the optimal duration of PP sessions remains unclear. We searched to evaluate the time required to obtain the maximum physiological effect, and to search for parameters related to patient survival in PP.<h4>Methods and results</h4>It was a prospective, monocentric, physiological study. We included in the study all prone-positioned patients in our ICU between June 2016 and January 2018. Pulmonary mech ...[more]

PMID: 32449068

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Project description:BACKGROUND:Hemodynamic response to prone position (PP) has never been studied in a large series of patients with acute respiratory distress syndrome (ARDS). The primary aim of this study was to estimate the rate of PP sessions associated with cardiac index improvement. Secondary objective was to describe hemodynamic response to PP and during the shift from PP to supine position. METHODS:The study was a single-center retrospective observational study, performed on ARDS patients, undergoing at least one PP session under monitoring by transpulmonary thermodilution. PP sessions performed more than 10 days after ARDS onset, or with any missing cardiac index measurements before (T1), at the end (T3), and after the PP session (T4) were excluded. Changes in hemodynamic parameters during PP were tested after statistical adjustment for volume of fluid challenges, vasopressor and dobutamine dose at each time point to take into account therapeutic changes during PP sessions. RESULTS:In total, 107 patients fulfilled the inclusion criteria, totalizing 197 PP sessions. Changes in cardiac index between T1 and T2 (early response to PP) and between T1 and T3 (late response to PP) were significantly correlated (R2?=?0.42, p?<?0.001) with a concordance rate amounting to 85%. Cardiac index increased significantly between T1 and T3 in 49 sessions (25% [95% confidence interval (CI95%) 18-32%]), decreased significantly in 46 (23% [CI95% 16-31%]), and remained stable in 102 (52% [CI95% 45-59%]). Global end-diastolic volume index (GEDVI) increased slightly but significantly from 719?±?193 mL m-2 at T1 to 757?±?209 mL m-2 at T3 and returned to baseline values at T4. Cardiac index and oxygen delivery decreased slightly but significantly from T3 to T4, without detectable increase in lactate level. Patients who increased their cardiac index during PP had significantly lower CI, GEDVI, global ejection fraction at T1, and received significantly more fluids than patients who did not. CONCLUSION:PP is associated with an increase in cardiac index in 18% to 32% of all PP sessions and a sustained increase in GEDVI reversible after return to supine position. Return from prone to supine position is associated with a slight hemodynamic impairment.

Project description:BACKGROUND:Increasing evidence suggests that sleep duration is associated with risks of various diseases including type 2 diabetes, cardiovascular disease (CVD), and certain types of cancer. However, the relationship with mortality is not clear, particularly in non-European populations. In this study, we investigated the association between sleep duration and mortality in a population-based prospective cohort of Korean adults. METHODS:This analysis included 34,264 participants (14,704 men and 19,560 women) of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2013 who agreed to mortality follow-up through December 31, 2016. Sleep duration was self-reported at baseline and was categorized into four groups: ?4, 5-6, 7-8, and???9?h/day. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations with mortality (all-cause as well as CVD- and cancer-specific), adjusting for potential confounders. RESULTS:During up to 9.5?years of follow-up, we identified a total of 1028 deaths. We observed the lowest mortality at 5-6?h/day sleep. Compared with 7-8?h/day of sleep, short (?4?h/day) and long (?9?h/day) sleep were associated with a 1.05-fold (95% CI?=?0.79-1.39) and 1.47-fold (95% CI?=?1.15-1.87) higher all-cause mortality, respectively. After additional adjustment for self-rated health, the positive association with short sleep disappeared (HR?=?0.99, 95% CI?=?0.75-1.32) and the association with long sleep was slightly attenuated (HR?=?1.38, 95% CI?=?1.08-1.76). Long sleep was also nonsignificantly positively associated with both cancer-mortality (HR?=?1.30, 95% CI?=?0.86-1.98) and CVD-mortality (HR?=?1.27, 95% CI?=?0.73-2.21). There was no statistically significant evidence for nonlinearity in the relationships between sleep duration and mortality (all-cause as well as CVD- and cancer-specific). Effect modification by age, sex, education, and occupation were not statistically significant. CONCLUSIONS:Our findings suggest that long sleep duration is associated with an increased all-cause mortality in Korean adults.

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Duration of prone position sessions: a prospective cohort study.

Publications

Duration of prone position sessions: a prospective cohort study.

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