Document Detail


Improvement in oxygenation by prone position and nitric oxide in patients with acute respiratory distress syndrome.
MedLine Citation:
PMID:  10051075     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Inhaled nitric oxide (NO) and prone position improve arterial oxygenation in patients with the acute respiratory distress syndrome. This study was undertaken to assess the combined effects of NO and prone position in these patients.
DESIGN: Prospective clinical study.
SETTING: General intensive care service in a community teaching hospital.
PATIENTS: 14 mechanically ventilated adult patients with the acute respiratory distress syndrome (mean lung injury score 3.23+/-0.27).
MEASUREMENTS AND RESULTS: We measured hemodynamic and oxygenation parameters in the supine position and 2 h later in the prone position, before and during inhalation of 10 ppm NO. A positive response in oxygenation was defined as a > or =20% increment in the arterial oxygen tension/fractional inspired oxygen ratio (PaO2/FIO2). In the prone position PaO2/FIO2 increased significantly (from 110+/-55 to 161+/-89 mm Hg, p<0.01) and venous admixture decreased (from 38+/-12 to 30+/-7%, p<0.01) compared to the supine position. Ten of the 14 patients were responders in the prone position. In the supine position, inhalation of NO improved oxygenation to a lesser extent, increasing PaO2/FIO2 to 134+/-64 mm Hg (p<0.01) and decreasing venous admixture to 35+/-12%, (p<0.01). Five of the 14 patients responded to NO inhalation supine and 8 of 14 responded prone (p = 0.22). The combination of NO therapy and prone positioning was additive in increasing PaO2/FIO2 (197+/-92 mm Hg) and decreasing venous admixture (27+/-8%) (p<0.01). This combination also showed a positive oxygenation response on compared to the supine value without NO in 13 of the 14 patients (93 %). NO-induced changes in PaO2/FIO2 were correlated to changes in pulmonary vascular resistance only in the prone position.
CONCLUSIONS: In patients with the acute respiratory distress syndrome, the combination of NO and prone position is a valuable adjunct to mechanical ventilation.
Authors:
M Martinez; E Diaz; D Joseph; A Villagrá; A Mas; R Fernandez; L Blanch
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Intensive care medicine     Volume:  25     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-05-20     Completed Date:  1999-05-20     Revised Date:  2012-01-23    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  29-36     Citation Subset:  IM    
Affiliation:
Intensive Care Service, Hospital de Sabadell, Universitat Autonoma de Barcelona, Parc Tauli s/n, E-08208 Sabadell, [corrected] Spain.
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Adult
Aged
Bronchodilator Agents / therapeutic use*
Female
Hemodynamics*
Humans
Male
Middle Aged
Nitric Oxide / therapeutic use*
Oxygen / blood
Positive-Pressure Respiration*
Prone Position
Prospective Studies
Pulmonary Ventilation*
Respiratory Distress Syndrome, Adult / physiopathology,  therapy*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Bronchodilator Agents; 10102-43-9/Nitric Oxide; 7782-44-7/Oxygen
Comments/Corrections
Erratum In:
Intensive Care Med. 2012 Jan;38(1):180

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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