• Jean-Michel Maillet, Stéphane Thierry, and Denis Brodaty.
• Cardiovascular and Thoracic Surgery Intensive Care Unit, Centre Cardiologique du Nord, Saint-Denis Cedex, France. jm.maillet@ccncardio.com
• J. Cardiothorac. Vasc. Anesth. 2008 Jun 1; 22 (3): 414417414-7.

ObjectiveTo determine the feasibility, safety, and efficacy on PaO(2)/F(I)O(2) ratio of prone positioning (PP) for acute respiratory distress syndrome (ARDS) after cardiac surgery.DesignRetrospective review of information entered prospectively in the authors' database.SettingA private community nonteaching hospital.ParticipantsSixteen patients who developed ARDS after cardiac surgery from January 2004 through June 2005.InterventionsPP to improve oxygenation.Measurements And Main ResultsAfter a median duration of 18 (range, 14-27) hours in PP, PaO(2)/F(I)O(2) improved in 14 (87.5%) patients. For the entire population, median PaO(2)/F(I)O(2) rose from 87 (range, 56-161) before PP to 194 (range, 94-460; p < 0.05) after it. After supine repositioning (SR), PaO(2)/F(I)O(2) declined to 146 (range, 72-320; not significant). PaO(2)/F(I)O(2) at the end of PP and 1 day after SR were comparable, respectively, 194 (range, 94-460) and 184 (range, 105-342). No severe complication was associated with PP, but 5 patients developed pressure sores and 2 others had superficial sternal wound infections. Intensive care unit mortality of 37.5% reflected the number of organ failure(s); there were no deaths with 2 failures, and 60% with > or = 3 organ failures died (p = 0.03). Mortality rates were comparable regardless of whether patients were PaO(2)/F(I)O(2) responders or their PaCO(2) decreased by > or = 1 mmHg.ConclusionPP to treat ARDS after cardiac surgery is feasible, safe, and can efficiently improve oxygenation. Measures to prevent pressure sores are mandatory.

19 keywords...

hide…