Highlights
- •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.
Abstract
Background
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.
Objective
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
Abbreviations:
PP (prone positioning)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 29, 2022
Accepted:
May 20,
2022
Received in revised form:
May 10,
2022
Received:
November 28,
2021
Footnotes
Funding information: Medical and Health Development Program Foundation of Shandong Province(202014051412).
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
