Posición prona para el manejo del paciente con SIRA

Abstract

OBJECTIVE: TO EVALUATE THE EFFECT OF THE PRONE POSITION IN THE OXYGENATION OF PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME. METHODOLOGY: OPEN, EXPERIMENTAL CLINICAL STUDY. LOCATION: INTENSIVE CARE UNIT. PATIENTS AND METHODS: FIVE PATIENTS WITH ACUTE RESPIRATORY SYNDROME WERE STUDIED, 4 SECONDARY TO INFECTION AND 1 WITH PANCREATITIS. ALL PRESENTED A KIRBY INDEX < 200 AND A MURRAY INDEX > 2.5, AND AN INSPIRED FRACTION OF OXYGEN > 80%, BEFORE BEING PLACED IN THE PRONE POSITION. THE PATIENTS WERE PLACED IN THE PRONE POSITION WITHOUT CHANGING THE INITIAL STANDARD VENTILATION AND THEY WERE EVALUATED THROUGH GASEOUS MEASURES AND THE KIRBY INDEX. ALSO, XRAY STUDIES AND CAT SCAN OF THE THORAX WERE DONE BEFORE POSITIONING AND 24 AND 48 HOURS AFTERWORDS IN ORDER TO EVALUATE THE EXTENSION AND EVOLUTION OF INFILTRATES AND ALVEOLAR CONDENSATION. RESULTS: ALL 5 PATIENTS RESPONDED TO BEING PLACED IN THE PRONE POSITION. THERE WAS AN STATISTICAL SIGNIFICANT INCREASE OF THE OXYGENATION INDEX, WHICH WAS ASSOCIATED WITH THE DECREASE AND REDISTRIBUTION OF INFILTRATES AND ALVEOLAR CONDENSATION. THE IMPROVEMENT IN THE OXYGENATION INDEX WAS RAPID AND SUSTAINED, AND PERSISTED AFTER THE RETURN TO THE SUPINE POSITION. ALL OF THE PATIENTS SURVIVED. CONCLUSIONS: WHEN USED AT AN EARLY STAGE, THE PRONE POSITION IMPROVES OXYGENATION, LIMITS PULMONARY DAMAGE AND FURTHERMORE, REDISTRIBUTES AND LIMITS ALVEOLAR CONDENSATION IN PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME.