Annals of Intensive Care | |
Predictors of survival in patients with influenza pneumonia-related severe acute respiratory distress syndrome treated with prone positioning | |
TSIRC (Taiwan Severe Influenza Research Consortium)1  Chieh-Liang Wu2  Kuang-Yao Yang3  Wei-Chih Chen3  Ko-Wei Chang4  Li-Chung Chiu4  Han-Chung Hu4  Kuo-Chin Kao4  Hao-Chien Wang5  Ying-Chun Chien5  Ming-Cheng Chan6  Wen-Feng Fang7  Yu-Mu Chen7  Wann-Cherng Perng8  Chung-Kan Peng8  Ming-Ju Tsai9  Chau-Chyun Sheu9  Shinn-Jye Liang1,10  | |
[1] ;Center for Quality Management, Taichung Veterans General Hospital;Department of Chest Medicine, Taipei Veterans General Hospital;Department of Thoracic Medicine, Chang Gung Memorial Hospital;Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital;Division of Chest Medicine, Department of Internal Medicine, and Section of Critical Care and Respiratory Therapy, Taichung Veterans General Hospital;Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital;Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center;Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital;Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital; | |
关键词: ARDS; Prone positioning; Influenza; Driving pressure; Mortality; | |
DOI : 10.1186/s13613-018-0440-4 | |
来源: DOAJ |
【 摘 要 】
Abstract Background Patients with influenza complicated with pneumonia are at high risk of rapid progression to acute respiratory distress syndrome (ARDS). Prone positioning with longer duration and lung-protective strategies might reduce the mortality level in ARDS. The aim of this study is to investigate the survival predictors of prone positioning in patients with ARDS caused by influenza pneumonia. Methods This retrospective study was conducted by eight tertiary referral centers in Taiwan. From January 1 to March 31 in 2016, all of the patients in intensive care units with virology-proven influenza pneumonia were collected, while all of those patients with ARDS and receiving prone positioning were enrolled. Demographic data, laboratory examinations, management records, ventilator settings and clinical outcomes were collected for analysis. Results During the study period, 336 patients with severe influenza pneumonia were screened and 263 patients met the diagnosis of ARDS. Totally, 65 patients receiving prone positioning were included for analysis. The 60-day survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II score, pneumonia severity index (PSI), creatinine level and lower rate of receiving renal replacement therapy than non-survivors (22.4 ± 8.5 vs. 29.2 ± 7.4, p = 0.003; 106.6 ± 40.9 vs. 135.3 ± 48.6, p = 0.019; 1.2 ± 0.9 mg/dL vs. 3.1 ± 3.6 mg/dL, p = 0.040; and 4% vs. 42%, p < 0.005). Multivariate Cox regression analysis identified PSI (hazard ratio 1.020, 95% confidence interval 1.009–1.032; p < 0.001), renal replacement therapy (hazard ratio 6.248, 95% confidence interval 2.245–17.389; p < 0.001), and increase in dynamic driving pressure (hazard ratio 1.372, 95% confidence interval 1.095–1.718; p = 0.006) which were independent predictors associated with 60-day mortality. Conclusions In the present study, in evaluating the effect of prone positioning in patients with influenza pneumonia-related ARDS, pneumonia severity index, renal replacement therapy and increase in dynamic driving pressure were associated with 60-day mortality in patients with influenza pneumonia-related ARDS receiving prone positioning.
【 授权许可】
Unknown