Prone positioning in extubated patients with hypoxemic respiratory failure after cardiac surgery: A retrospective study


      • Hypoxemic respiratory failure is a serious complication that results in high mortality after cardiac surgery. It can occur at any stage after cardiac surgery, such as during endotracheal tube removal.
      • Prone positioning is effective and safe for extubated cardiac surgery patients with hypoxemic respiratory failure; prone position ventilation may be associated with improved oxygenation and respiratory conditions and lower secondary intubation rates.
      • No serious adverse events have been observed.



      Hypoxemic respiratory failure is a serious complication that can occur at any stage after cardiac surgery. Prone positioning (PP) is safe and effective for patients receiving invasive ventilation after hypoxemic respiratory failure; however, few related studies have focused on its use with extubated cardiac surgery patients. Researchers recently reported beneficial effects of PP for hypoxemic patients with COVID-19 and those with moderate ARDS (acute respiratory distress syndrome,ARDS). PP may also improve oxygenation in extubated cardiac surgery patients.


      In this study, we aimed to assess the safety and effectiveness of PP in extubated cardiac surgery patients to determine whether PP can improve oxygenation and respiratory status or reduce secondary intubation.


      We reviewed our institutional database between August 2018 and August 2020 and identified 22 cardiac surgery patients who had undergone PP for hypoxemic respiratory failure after extubation. From the medical and nursing records, we extracted the following data recorded before PP, during PP, and after PP for each patient, arterial blood gas analyses, hemodynamic records, laboratory reports, and respiratory function training records.


      Twenty-two extubated patients underwent 74 PP. Each patient underwent a median of 3.5 (2–5) procedures, and the median duration of each PP was 10 h. PP was implemented on the 4.5th postoperative day (median). All patients were discharged from the hospital, and none died. No complications were observed. PP improved the P/F ratio (182.65 ± 60.17, 301.53 ± 61.31, and 246.76 ± 65.68, before PP, during PP, and after PP, respectively, p < 0.001). Additionally, the respiratory rate, Forced Vital Capacity (FVC) and PaCO2 also improved, and hemodynamics showed no significant change.


      PP may be effective and safe for treating patients who are extubated following cardiac surgery with hypoxemic respiratory failure. For these patients, PP is associated with oxygenation and respiratory condition improvements and low secondary intubation rates.



      PP (prone positioning)
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