Efficacy of prone positioning ventilation in acute respiratory distress syndrome after acute Stanford type A aortic dissection surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Junhao , CHEN Huilong , WANG Juxiang , ZHENG Weiliang , WU Chuang , LIU Jingqian ,  WU Xijie

School of Medicine, Xiamen University, Xiamen Cardiovascular Hospital of Xiamen University, Xiamen, 361000, Fujian, P. R. China;

Corresponding author：

WU Xijie, Email: wxjusa@163.com

Keywords：

Prone positioning; acute Stanford type A aortic dissection; acute respiratory distress syndrome

DOI：

10.7507/1007-4848.202204064

Video：

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Objective To explore the efficacy of prone positioning ventilation in patients with acute respiratory distress syndrome (ARDS) after acute Stanford type A aortic dissection (STAAD) surgery. Methods From November 2019 to September 2021, patients with ARDS who was placed prone position after STAAD surgery in the Xiamen Cardiovascular Hospital of Xiamen University were collected. Data such as the changes of blood gas, respiratory mechanics and hemodynamic indexes before and after prone positioning, complications and prognosis were collected for statistical analysis. Results A total of 264 STAAD patients had surgical treatment, of whom 40 patients with postoperative ARDS were placed prone position. There were 37 males and 3 females with an average age of 49.88±11.46 years. The oxygen partial pressure, oxygenation index and peripheral blood oxygen saturation 4 hours and 12 hours after the prone positioning, and 2 hours and 6 hours after the end of the prone positioning were significantly improved compared with those before prone positioning ventilation (P<0.05). The oxygenation index 2 hours after the end of prone positioning which was less than 131.42 mm Hg, indicated that the patient might need ventilation two or more times of prone position. Conclusion Prone position ventilation for patients with moderate to severe ARDS after STAAD surgery is a safe and effective way to improve the oxygenation.

Citation： XIE Junhao, CHEN Huilong, WANG Juxiang, ZHENG Weiliang, WU Chuang, LIU Jingqian, WU Xijie. Efficacy of prone positioning ventilation in acute respiratory distress syndrome after acute Stanford type A aortic dissection surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(1): 116-121. doi: 10.7507/1007-4848.202204064 Copy

1.	Mussa FF, Horton JD, Moridzadeh R, et al. Acute aortic dissection and intramural hematoma: A systematic review. JAMA, 2016, 316(7): 754-763.
2.	Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg, 2016, 5(4): 275-295.
3.	Kowalik MM, Lango R, Siondalski P, et al. Clinical, biochemical and genetic risk factors for 30-day and 5-year mortality in 518 adult patients subjected to cardiopulmonary bypass during cardiac surgery—The INFLACOR study. Acta Biochim Pol, 2018, 65(2): 241-250.
4.	Davidson SM, Ferdinandy P, Andreadou I, et al. Multitarget strategies to reduce myocardial ischemia/reperfusion injury: JACC review topic of the week. J Am Coll Cardiol, 2019, 73(1): 89-99.
5.	Puchinger J, Ryz S, Nixdorf L, et al. Characteristics of interleukin-6 signaling in elective cardiac surgery—A prospective cohort study. J Clin Med, 2022, 11(3): 590.
6.	Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med, 2013, 368(23): 2159-2168.
7.	Santarpino G, Bonifazi R, Albanese M, et al. Prone positioning in postoperative cardiac surgery patients: A narrative review. J Cardiothorac Vasc Anesth, 2022, 36(8 Pt A): 2636-2642.
8.	Martinsson A, Houltz E, Wallinder A, et al. Lung recruitment in the prone position after cardiac surgery: A randomised controlled study. Br J Anaesth, 2021, 126(5): 1067-1074.
9.	Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
10.	Ji Q, Lai H, Sun Y, et al. Impact of presurgical mild acute respiratory distress syndrome on surgical mortality after surgical repair of acute type A aortic dissection. Int Heart J, 2017, 58(5): 739-745.
11.	Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3): 691-696.
12.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: The Berlin definition. JAMA, 2012, 307(23): 2526-2533.
13.	Wu Z, Ruan Y, Chang J, et al. Angiotensin Ⅱ is related to the acute aortic dissection complicated with lung injury through mediating the release of MMP9 from macrophages. Am J Transl Res. 2016, 8(3): 1426-1436.
14.	Kashiwagi Y, Komukai K, Suzuki K, et al. Predictors of oxygenation impairment in medical treatment for type B acute aortic dissection. Heart Vessels, 2018, 33(12): 1463-1470.
15.	Gong M, Wu Z, Xu S, et al. Increased risk for the development of postoperative severe hypoxemia in obese women with acute type A aortic dissection. J Cardiothorac Surg, 2019, 14(1): 81.
16.	Nakajima T, Kawazoe K, Izumoto H, et al. Risk factors for hypoxemia after surgery for acute type A aortic dissection. Surg Today, 2006, 36(8): 680-685.
17.	Chen MF, Chen LW, Cao H, et al. Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection. J Thorac Dis, 2016, 8(10): 2862-2871.
18.	Su IL, Wu VC, Chou AH, et al. Risk factor analysis of postoperative acute respiratory distress syndrome after type A aortic dissection repair surgery. Medicine (Baltimore), 2019, 98(29): e16303.
19.	Lim CM, Kim EK, Lee JS, et al. Comparison of the response to the prone position between pulmonary and extrapulmonary acute respiratory distress syndrome. Intensive Care Med, 2001, 27(3): 477-485.
20.	Liaqat A, Mason M, Foster BJ, et al. Evidence-based mechanical ventilatory strategies in ARDS. J Clin Med, 2022, 11(2): 319.
21.	Zhang J, Yang Z, Chen K, et al. Efficacy of adaptive ventilation support combined with lung recruitment maneuvering for acute respiratory distress syndrome. Am J Transl Res, 2022, 14(3): 2109-2116.
22.	Mekontso Dessap A, Boissier F, Charron C, et al. Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: Prevalence, predictors, and clinical impact. Intensive Care Med, 2016, 42(5): 862-870.
23.	Nielsen J, Nilsson M, Fredén F, et al. Central hemodynamics during lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia. A study by echocardiography and continuous pulmonary artery flow measurements in lung-injured pigs. Intensive Care Med, 2006, 32(4): 585-594.
24.	Lovas A, Szakmány T. Haemodynamic effects of lung recruitment manoeuvres. Biomed Res Int, 2015, 2015: 478970.
25.	Jozwiak M, Teboul JL, Anguel N, et al. Beneficial hemodynamic effects of prone positioning in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med, 2013, 188(12): 1428-1433.
26.	Repessé X, Charron C, Vieillard-Baron A. Acute cor pulmonale in ARDS: Rationale for protecting the right ventricle. Chest, 2015, 147(1): 259-265.
27.	赵荣, 胡雪慧, 张平, 等. 俯卧位通气在主动脉夹层术后顽固性低氧血症的治疗策略. 中国体外循环杂志, 2020, 18(1): 38-41.
28.	Douville EC, Asaph JW, Dworkin RJ, et al. Sternal preservation: A better way to treat most sternal wound complications after cardiac surgery. Ann Thorac Surg, 2004, 78(5): 1659-1664.

1. Mussa FF, Horton JD, Moridzadeh R, et al. Acute aortic dissection and intramural hematoma: A systematic review. JAMA, 2016, 316(7): 754-763.
2. Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg, 2016, 5(4): 275-295.
3. Kowalik MM, Lango R, Siondalski P, et al. Clinical, biochemical and genetic risk factors for 30-day and 5-year mortality in 518 adult patients subjected to cardiopulmonary bypass during cardiac surgery—The INFLACOR study. Acta Biochim Pol, 2018, 65(2): 241-250.
4. Davidson SM, Ferdinandy P, Andreadou I, et al. Multitarget strategies to reduce myocardial ischemia/reperfusion injury: JACC review topic of the week. J Am Coll Cardiol, 2019, 73(1): 89-99.
5. Puchinger J, Ryz S, Nixdorf L, et al. Characteristics of interleukin-6 signaling in elective cardiac surgery—A prospective cohort study. J Clin Med, 2022, 11(3): 590.
6. Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med, 2013, 368(23): 2159-2168.
7. Santarpino G, Bonifazi R, Albanese M, et al. Prone positioning in postoperative cardiac surgery patients: A narrative review. J Cardiothorac Vasc Anesth, 2022, 36(8 Pt A): 2636-2642.
8. Martinsson A, Houltz E, Wallinder A, et al. Lung recruitment in the prone position after cardiac surgery: A randomised controlled study. Br J Anaesth, 2021, 126(5): 1067-1074.
9. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
10. Ji Q, Lai H, Sun Y, et al. Impact of presurgical mild acute respiratory distress syndrome on surgical mortality after surgical repair of acute type A aortic dissection. Int Heart J, 2017, 58(5): 739-745.
11. Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3): 691-696.
12. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: The Berlin definition. JAMA, 2012, 307(23): 2526-2533.
13. Wu Z, Ruan Y, Chang J, et al. Angiotensin Ⅱ is related to the acute aortic dissection complicated with lung injury through mediating the release of MMP9 from macrophages. Am J Transl Res. 2016, 8(3): 1426-1436.
14. Kashiwagi Y, Komukai K, Suzuki K, et al. Predictors of oxygenation impairment in medical treatment for type B acute aortic dissection. Heart Vessels, 2018, 33(12): 1463-1470.
15. Gong M, Wu Z, Xu S, et al. Increased risk for the development of postoperative severe hypoxemia in obese women with acute type A aortic dissection. J Cardiothorac Surg, 2019, 14(1): 81.
16. Nakajima T, Kawazoe K, Izumoto H, et al. Risk factors for hypoxemia after surgery for acute type A aortic dissection. Surg Today, 2006, 36(8): 680-685.
17. Chen MF, Chen LW, Cao H, et al. Analysis of risk factors for and the prognosis of postoperative acute respiratory distress syndrome in patients with Stanford type A aortic dissection. J Thorac Dis, 2016, 8(10): 2862-2871.
18. Su IL, Wu VC, Chou AH, et al. Risk factor analysis of postoperative acute respiratory distress syndrome after type A aortic dissection repair surgery. Medicine (Baltimore), 2019, 98(29): e16303.
19. Lim CM, Kim EK, Lee JS, et al. Comparison of the response to the prone position between pulmonary and extrapulmonary acute respiratory distress syndrome. Intensive Care Med, 2001, 27(3): 477-485.
20. Liaqat A, Mason M, Foster BJ, et al. Evidence-based mechanical ventilatory strategies in ARDS. J Clin Med, 2022, 11(2): 319.
21. Zhang J, Yang Z, Chen K, et al. Efficacy of adaptive ventilation support combined with lung recruitment maneuvering for acute respiratory distress syndrome. Am J Transl Res, 2022, 14(3): 2109-2116.
22. Mekontso Dessap A, Boissier F, Charron C, et al. Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: Prevalence, predictors, and clinical impact. Intensive Care Med, 2016, 42(5): 862-870.
23. Nielsen J, Nilsson M, Fredén F, et al. Central hemodynamics during lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia. A study by echocardiography and continuous pulmonary artery flow measurements in lung-injured pigs. Intensive Care Med, 2006, 32(4): 585-594.
24. Lovas A, Szakmány T. Haemodynamic effects of lung recruitment manoeuvres. Biomed Res Int, 2015, 2015: 478970.
25. Jozwiak M, Teboul JL, Anguel N, et al. Beneficial hemodynamic effects of prone positioning in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med, 2013, 188(12): 1428-1433.
26. Repessé X, Charron C, Vieillard-Baron A. Acute cor pulmonale in ARDS: Rationale for protecting the right ventricle. Chest, 2015, 147(1): 259-265.
27. 赵荣, 胡雪慧, 张平, 等. 俯卧位通气在主动脉夹层术后顽固性低氧血症的治疗策略. 中国体外循环杂志, 2020, 18(1): 38-41.
28. Douville EC, Asaph JW, Dworkin RJ, et al. Sternal preservation: A better way to treat most sternal wound complications after cardiac surgery. Ann Thorac Surg, 2004, 78(5): 1659-1664.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of prone positioning ventilation in acute respiratory distress syndrome after acute Stanford type A aortic dissection surgery

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