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Article Dans Une Revue Critical Care Medicine Année : 2022

Prone-positioning for severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation

Résumé

Objectives: To determine the characteristics and outcomes of patients prone-positioned during extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and lung CT pattern associated with improved respiratory system static compliance after that intervention. Design: Retrospective, single-center study over 8 years. Settings: Twenty-six bed ICU in a tertiary center. Measurements and main results: A propensity score-matched analysis compared patients with prone-positioning during extracorporeal membrane oxygenation and those without. An increase of the static compliance greater than or equal to 3 mL/cm H2O after 16 hours of prone-positioning defined prone-positioning responders. The primary outcome was the time to successful extracorporeal membrane oxygenation weaning within 90 days of postextracorporeal membrane oxygenation start, with death as a competing risk. Among 298 venovenous extracorporeal membrane oxygenation-treated adults with severe acute respiratory distress syndrome, 64 were prone-positioning extracorporeal membrane oxygenation. Although both propensity score-matched groups had similar extracorporeal membrane oxygenation durations, prone-positioning extracorporeal membrane oxygenation patients' 90-day probability of being weaned-off extracorporeal membrane oxygenation and alive was higher (0.75 vs 0.54, p = 0.03; subdistribution hazard ratio [95% CI], 1.54 [1.05-2.58]) and 90-day mortality was lower (20% vs 42%, p < 0.01) than that for no prone-positioning extracorporeal membrane oxygenation patients. Extracorporeal membrane oxygenation-related complications were comparable for the two groups. Patients without improved static compliance had higher percentages of nonaerated or poorly aerated ventral and medial-ventral lung regions (p = 0.047).
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Dates et versions

hal-03983252 , version 1 (10-02-2023)

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Matthieu Petit, Catalin Fetita, Augustin Gaudemer, Ludovic Treluyer, Guillaume Lebreton, et al.. Prone-positioning for severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Critical Care Medicine, 2022, 50 (2), pp.264-274. ⟨10.1097/CCM.0000000000005145⟩. ⟨hal-03983252⟩
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