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Therapeutic Evaluation of Computed Tomography Findings for Efficacy of Prone Ventilation in Acute Respiratory Distress Syndrome Patients with Abdominal Surgery Cover

Therapeutic Evaluation of Computed Tomography Findings for Efficacy of Prone Ventilation in Acute Respiratory Distress Syndrome Patients with Abdominal Surgery

The Journal of Critical Care Medicine
Volume 6 (2020): Issue 1 (January 2020)
By: ,  ,   and    
Open Access
|Jan 2020
Figures & tables

Figures & Tables

Table1

Patients’ demographic data

Group AGroup BP
Number2427
Age (year-old)71.0 ± 11.268.9 ± 12.20.508
Male / Female17 / 718 / 90.772
APACHE II21.0 ± 5.820.4 ± 6.40.734
SOFA7.3 ± 3.17.9 ± 3.40.469
Shock, n (%)9 (37.5)14 (51.9)0.400
Surgical site
Upper tract15120.162
Lower tract815
Miscellaneous10
Drug therapy
Steroid, n (%)5 (20.8)11 (40.7)0.145
Ventilator settings at the start of the study
PEEP (cmH2O)10.3 ± 2.39.0 ± 3.20.116
Peak pressure (cmH2O)19.5 ± 4.518.3 ± 5.70.426
Respiratory rate21.5 ± 6.822.6 ± 7.70.584
PaO2 /FiO2
At the start of mechanical ventilation118 ± 41141 ± 420.030
At the time after the start of the study
0 h154 ± 41156 ± 300.841
12 h223 ± 63166 ± 46< 0.001
24 h245 ± 82182 ± 490.002
48 h265 ± 76202 ± 46< 0.001
72 h290 ± 75226 ± 650.002
CT scan findings
GGO590.243
DLA179
GGO + DLA29
Ventilator free days17.4 ± 9.111.5 ± 9.80.032
ICU free days14.4 ± 9.110.0 ± 9.20.095
28-day mortality, n (%)4 (16.7)10 (37.0)0.127
90-day mortality, n (%)5 (20.8)13 (48.1)0.048

[i] NOTE. Plus-minus values are means ± standard deviation. Abbreviations: APACHE II, acute physiology and chronic health evaluation II; SOFA, sequential organ failure assessment; PEEP, positive end-expiratory pressure; GGO, ground-glass opacity; DLA, dorsal lung atelectasis.

Fig. 1

Comparison of weaning rates from mechanical ventilation between the prone and supine ventilation groups in patients with intra-abdominal sepsis-induced ARDS. Cumulative weaning rate over 28 days was compared using the log-rank test. ARDS: acute respiratory distress syndrome

Fig. 2

Comparison of weaning rates from mechanical ventilation between the prone and supine ventilation groups in patients with DLA findings (A) and GGO findings (B) on CT scan. Cumulative weaning rate from mechanical ventilation in each group was compared using the log-rank test. DLA: dorsal lung atelectasis; GGO: ground glass opacification; CT: computed tomography

Table 2

Demographic data of patients in whom CT scan shows dorsal lung atelectasis and ground glass opacification

Dorsal Lung AtelectasisGround Glass Opacification
Group AGroup BpGroup AGroup Bp
Number17959
Age (year-old)69.2 ±10.769.4 ±13.20.96580.4 ±5.765.7 ±13.10.036
Male / Female11/65 / 40.6924 / 18 / 11.000
APACHE II19.8 ±5.220.9 ±8.60.67920.8 ±3.519.4 ±5.90.649
SOFA7.5 ±3.58.4 ±3.60.5127.4 ±1.96.3 ±2.50.435
Surgical site
Upper tract6354
Lower tract10605
Miscellaneous1000
Drug therapy Steroid, n(%)2(11.7)2(22.2)0.5912 (40.0)6 (66.7)0.580
Ventilator settings at the start of the study FiO20.7 ±0.20.6± 0.20.2390.7 ±0.20.7 ±0.10.884
PEEP(cmH2O)9.8 ±1.09.0 ±4.70.51512.0 ±4.79.1±1.10.093
Peak pressure (cmH20)19.4 ±3.916.2 ±5.20.38519.4 ±7.319.2 ±4.10.953
Respiratory rate22.2 ±7.319.9 ±5.50.42018.4 ±6.125.1 ±6.90.097
PaO2/FiO2
At the time after the start of the study
Oh157 ± 44173 ±320.325151 ±45150 ±210.958
72 h307 ± 62214 ±620.0010233 ± 89219 ±700.748

[i] Abbreviations: APACHE II, acute physiology and chronic health evaluation II; SOFA, sequential organ failure assessment; PEEP, positive end-expiratory pressure.

Table 3

Effect of prone ventilation on ventilator-free days, ICU-free days, and 28-day mortality in patients with CT SCAN findings of dorsal lung atelectasis or ground-glass opacification

Dorsal Lung AtelectasisGround Glass Opacification
Group AGroup BGroup AGroup B
Ventilator free days20.2 ±6.95.8 ±7.8< 0.0017.8 ±11.011.9 ±10.30.390
ICU free days16.9 ±7.54.1 ±7.2< 0.0017.4 ±10.411.8 ±9.80.339
28-day mortality, n (%)1(5.9)4 (44.4)0.0353 (60.0)4 (44.4)1.000
90-day mortality, n (%)2(11.8)5(55.6)0.0283 (60.0)5(55.6)1.000
DOI: https://doi.org/10.2478/jccm-2020-0003 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
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Language: English
Page range: 32 - 40
Submitted on: Sep 27, 2019
Accepted on: Jan 15, 2020
Published on: Jan 31, 2020
Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
prone position,
computed tomography,
acute respiratory distress syndrome
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Surgery,
Surgery, other,
Anaesthesiology,
Emergency medicine and intensive-care medicine

© 2020 Masayuki Akatsuka, Hiroomi Tatsumi, Naoya Yama, Yoshiki Masuda, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 6 (2020): Issue 1 (January 2020)
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