(1164) Synergistic Effects of Prone Positioning and Airway Pressure Release Ventilation for ARDS

Monday, January 22, 2024

10:15 AM – 11:15 AM MT

Location: Connections Central - RST 11

First Author(s)

PS

Preksha Shah

n/a

Co-Author(s)

AH

Arayn Hemani, MD

Medical Student
Spartan Health Sciences University
Oak Park, Illinois, United States
AK

Angelina Kozhokar, MD

Medical graduate, Master's student
Universitat Internacional de Catalunya, United States
TM

Thalia Melamed, N/A

Medical student
Queen Mary University of London, United States
AS

Alice Q. Schimit, N/A

Medical graduate
Medical Preceptor of Pontifical Catholic University of Poços de Caldas. Medical degree at University of São Paulo-SP, United States
LB

Luana C. Miantti Ghellere Bonfim, N/A

Medical Student
University of South Santa Catarina, United States
ML

Marcela Lopez, MD

Postdoctoral Research Fellow
The Louis Armstrong Center for Music and Medicine, Mount Sinai Hospitals, New York, NY, United States, United States

Introduction: Managing severe respiratory conditions like COVID-19 and H1N1 influenza is challenging, particularly due to acute respiratory distress syndrome (ARDS). A recent meta-analysis shows that airway pressure release ventilation (APRV) improves oxygenation and ventilation-perfusion matching in ARDS patients. Additionally, prone positioning has demonstrated oxygenation improvement in 60—70% of ARDS cases. However, the combination of APRV and prone positioning remains unexplored due to the dominance of assist/controlled ventilation in clinical practice. This systematic literature review aims to investigate the effect of prone positioning on oxygenation in APRV compared to SIMV-PC/PS mechanically-ventilated ARDS patients.

Methods: We conducted a systematic literature review by searching PubMed, Embase, and Cochrane for studies meeting inclusion criteria: simultaneous use of prone positioning and APRV, with primary outcomes focusing on oxygenation improvement and mortality. Case-reports/case-series were excluded.

Results: The review includes three eligible studies, with 51 patients in the APRV group and 43 in the conventional group. Baseline characteristics showed no significant differences. Two studies reported increases in oxygenation after the second prone position in the APRV group compared to the control group: (i) 82 (37.0—141.0) vs. 50 (24.0—68.8) mmHg, (p=0.02); (ii) 189 (150-237) vs. 127 (100-146) mmHg, (p=0.025). In the third study, 11 of 14 patients experienced refractory hypoxemia in the APRV group, but improvement occurred after prone positioning. Serious complications and 28-day mortality were similar in both groups across all studies. One limitation is differing protocols for APRV and proning, but results remain significant.

Conclusions: Prone positioning and APRV ventilation seems to have advantageous synergistic effects on oxygenation without increasing complications in patients with ARDS. This combination can be considered rescue therapy in refractory hypoxemia in this group of patients. However, improvement in oxygenation did not seem to benefit overall mortality. This analysis brings a hypothesis and further studies are necessary.