A Multicenter Retrospective Review of Prone Position Ventilation (PPV) in Treatment of Severe Human H7N9 Avian Flu

• Published in: PloS one Vol. 10; no. 8; p. e0136520
• Main Authors: Xu, Yuanda, Deng, Xilong, Han, Yun, Zhou, Lixin, He, Weiqun, Chen, Sibei, Nong, Lingbo, Huang, Huang, Zhang, Yan, Yu, Tieou, Li, Yimin, Liu, Xiaoqing
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.08.2015; Public Library of Science (PLoS)
• Subjects: Aged; Antiviral drugs; Avian flu; Avian influenza; Blood pressure; Carbon dioxide; Chinese medicine; Critical care; Development and progression; Diagnosis; Drug therapy; Female; Heart diseases; Heart rate; Hemodynamics; Hospitals; Humans; Infections; Influenza A Virus, H7N9 Subtype; Influenza, Human - complications; Influenza, Human - therapy; Laboratories; Lactic acid; Lungs; Male; Mechanical ventilation; Middle Aged; Norepinephrine; Oxygenation; Partial pressure; Patient Positioning - adverse effects; Patient Positioning - methods; Patients; Physiological aspects; Physiology; Position measurement; Prone Position; Pulmonary Ventilation; Respiration; Respiration, Artificial - adverse effects; Respiration, Artificial - methods; Respiratory diseases; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - therapy; Respiratory rate; Respiratory therapy; Retrospective Studies; Substance abuse treatment; Supine position; Ventilation; Ventilators; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0136520

Patients with H7N9 avian flu concurrent with severe acute respiratory distress syndrome (ARDS) usually have a poor clinical outcome. Prone position ventilation (PPV) has been shown to improve the prognosis of patients with severe ARDS. This study explored the effects of PPV on the respiratory and circulatory mechanics of H7N9-infected patients with severe ARDS. Individuals admitted to four hospitals designated for H7N9 patients in Guangdong province were treated with PPV, and their clinical data were recorded before and after receiving PPV. Six of 20 critically ill patients in the ICU received PPV. After treatment with 35 PPV sessions, the oxygenation index (OI) values of the six patients when measured post-PPV and post-supine position ventilation (SPV) were significantly higher than those measured pre-PPV (P < 0.05).The six patients showed no significant differences in their values for respiratory rate (RR), peak inspiratory pressure (PIP), tidal volume (TV) or arterial partial pressure of carbon dioxide (PaCO2) when compared pre-PPV, post-PPV, and post-SPV. Additionally, there were no significant differences in the mean values for arterial pressure (MAP), cardiac index (CI), central venous pressure (CVP), heart rate (HR), lactic acid (LAC) levels or the doses of norepinephrine (NE) administered when compared pre-PPV, post-PPV, and post-SPV. PPV provided improved oxygenation that was sustained after returning to a supine position, and resulted in decreased carbon dioxide retention. PPV can thus serve as an alternative lung protective ventilation strategy for use in patients with H7N9 avian flu concurrent with severe ARDS.