Prone position: Does it help with acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO)?

Authors

Nava Azimzadeh, Thomas Jefferson UniversityFollow
Michael Baram, Thomas Jefferson UniversityFollow
Nicholas C. Cavarocchi, Thomas Jefferson UniversityFollow
Hitoshi Hirose, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

2-1-2017

Comments

This article has been peer reviewed. It is the author’s final published version in Open Journal of Respiratory Diseases.

Volume 7, Issue 1, February 2017, Pages 18-24.

The published version is available at DOI: 10.4236/ojrd.2017.71003 . Copyright © Azimzadeh et al.

Abstract

Introduction: Lung protective ventilation therapy with low tidal volume-high PEEP is the standard treatment for the patients with acute respiratory distress syndrome (ARDS). Oscillators are occasionally used for salvage ventilation in cases where poor compliance restricts the use of traditional ventilation with ARDS. In addition to ventilator therapy, prone positioning has been used to improve oxygenation. We presented a challenging case of ARDS, which failed medical management extracorporeal membrane oxygenation (ECMO) support and oscillatory ventilation. Prone positioning was initiated which improved oxygenation, respiratory compliance and posterior atelectasis. Case presentation: A 41-year-old morbid obese female developed ARDS due to influenza pneumonia. The patient remained hypoxic despite optimum medical and ventilator management and required veno-venous extracorporeal membrane oxygenation (VV ECMO). CT scan of the chest showed ARDS with posterior consolidation. Despite ARDSnet ventilation support, antiviral therapy and ECMO support, there was no clinical improvement. High frequency oscillatory ventilation was initiated on ECMO day #13, which resulted in no respiratory improvement over the next 5 days. On ECMO day #18, the patient was placed on a Rotaprone^? bed Therapy, utilizing a proning strategy of 16 hours a day. The clinical improvements observed were resolving of the consolidation on CXR, improvements in ventilatory parameters and decreased oxygen requirements. The patient was successfully weaned off ECMO on POD#25 (8 days post prone bed). Conclusions: Prone position improved oxygen saturation and pulmonary compliance in severe ARDS requiring ECMO and it might facilitate early weaning.

Recommended Citation

Azimzadeh, Nava; Baram, Michael; Cavarocchi, Nicholas C.; and Hirose, Hitoshi, "Prone position: Does it help with acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO)?" (2017). Department of Surgery Faculty Papers. Paper 142.
https://jdc.jefferson.edu/surgeryfp/142

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.