Prone positioning in ARDS patients supported with VV ECMO, what we should explore?
Abstract Background Acute respiratory distress syndrome (ARDS), a prevalent cause of admittance to intensive care units, is associated with high mortality. Prone positioning has been proven to improve the outcomes of moderate to severe ARDS patients owing to its physiological effects. Venovenous ext...
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40560-022-00640-5 |
| _version_ | 1828339652565663744 |
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| author | Hongling Zhang Zhengdong Liu Huaqing Shu Yuan Yu Xiaobo Yang Ruiting Li Jiqian Xu Xiaojing Zou You Shang |
| author_facet | Hongling Zhang Zhengdong Liu Huaqing Shu Yuan Yu Xiaobo Yang Ruiting Li Jiqian Xu Xiaojing Zou You Shang |
| author_sort | Hongling Zhang |
| collection | DOAJ |
| description | Abstract Background Acute respiratory distress syndrome (ARDS), a prevalent cause of admittance to intensive care units, is associated with high mortality. Prone positioning has been proven to improve the outcomes of moderate to severe ARDS patients owing to its physiological effects. Venovenous extracorporeal membrane oxygenation (VV ECMO) will be considered in patients with severe hypoxemia. However, for patients with severe hypoxemia supported with VV ECMO, the potential effects and optimal strategies of prone positioning remain unclear. This review aimed to present these controversial questions and highlight directions for future research. Main body The clinically significant benefit of prone positioning and early VV ECMO alone was confirmed in patients with severe ARDS. However, a number of questions regarding the combination of VV ECMO and prone positioning remain unanswered. We discussed the potential effects of prone positioning on gas exchange, respiratory mechanics, hemodynamics, and outcomes. Strategies to achieve optimal outcomes, including indications, timing, duration, and frequency of prone positioning, as well as the management of respiratory drive during prone positioning sessions in ARDS patients receiving VV ECMO, are challenging and controversial. Additionally, whether and how to implement prone positioning according to ARDS phenotypes should be evaluated. Lung morphology monitored by computed tomography, lung ultrasound, or electrical impedance tomography might be a potential indication to make an individualized plan for prone positioning therapy in patients supported with VV ECMO. Conclusion For patients with ARDS supported with VV ECMO, the potential effects of prone positioning have yet to be clarified. Ensuring an optimal strategy, especially an individualized plan for prone positioning therapy during VV ECMO, is particularly challenging and requires further research. |
| first_indexed | 2024-04-13T22:45:48Z |
| format | Article |
| id | doaj.art-a7e357f49a0746afbf8a6f783ff08dbb |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-04-13T22:45:48Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-a7e357f49a0746afbf8a6f783ff08dbb2022-12-22T02:26:24ZengBMCJournal of Intensive Care2052-04922022-10-0110111110.1186/s40560-022-00640-5Prone positioning in ARDS patients supported with VV ECMO, what we should explore?Hongling Zhang0Zhengdong Liu1Huaqing Shu2Yuan Yu3Xiaobo Yang4Ruiting Li5Jiqian Xu6Xiaojing Zou7You Shang8Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Intensive Care Unit, Affiliated Lu’an Hospital, Anhui Medical UniversityDepartment of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyAbstract Background Acute respiratory distress syndrome (ARDS), a prevalent cause of admittance to intensive care units, is associated with high mortality. Prone positioning has been proven to improve the outcomes of moderate to severe ARDS patients owing to its physiological effects. Venovenous extracorporeal membrane oxygenation (VV ECMO) will be considered in patients with severe hypoxemia. However, for patients with severe hypoxemia supported with VV ECMO, the potential effects and optimal strategies of prone positioning remain unclear. This review aimed to present these controversial questions and highlight directions for future research. Main body The clinically significant benefit of prone positioning and early VV ECMO alone was confirmed in patients with severe ARDS. However, a number of questions regarding the combination of VV ECMO and prone positioning remain unanswered. We discussed the potential effects of prone positioning on gas exchange, respiratory mechanics, hemodynamics, and outcomes. Strategies to achieve optimal outcomes, including indications, timing, duration, and frequency of prone positioning, as well as the management of respiratory drive during prone positioning sessions in ARDS patients receiving VV ECMO, are challenging and controversial. Additionally, whether and how to implement prone positioning according to ARDS phenotypes should be evaluated. Lung morphology monitored by computed tomography, lung ultrasound, or electrical impedance tomography might be a potential indication to make an individualized plan for prone positioning therapy in patients supported with VV ECMO. Conclusion For patients with ARDS supported with VV ECMO, the potential effects of prone positioning have yet to be clarified. Ensuring an optimal strategy, especially an individualized plan for prone positioning therapy during VV ECMO, is particularly challenging and requires further research.https://doi.org/10.1186/s40560-022-00640-5ARDSVV ECMOProne positioningEffectsIndividualized therapyComputed tomography |
| spellingShingle | Hongling Zhang Zhengdong Liu Huaqing Shu Yuan Yu Xiaobo Yang Ruiting Li Jiqian Xu Xiaojing Zou You Shang Prone positioning in ARDS patients supported with VV ECMO, what we should explore? Journal of Intensive Care ARDS VV ECMO Prone positioning Effects Individualized therapy Computed tomography |
| title | Prone positioning in ARDS patients supported with VV ECMO, what we should explore? |
| title_full | Prone positioning in ARDS patients supported with VV ECMO, what we should explore? |
| title_fullStr | Prone positioning in ARDS patients supported with VV ECMO, what we should explore? |
| title_full_unstemmed | Prone positioning in ARDS patients supported with VV ECMO, what we should explore? |
| title_short | Prone positioning in ARDS patients supported with VV ECMO, what we should explore? |
| title_sort | prone positioning in ards patients supported with vv ecmo what we should explore |
| topic | ARDS VV ECMO Prone positioning Effects Individualized therapy Computed tomography |
| url | https://doi.org/10.1186/s40560-022-00640-5 |
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