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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
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Prone positioning in ARDS patients supported with VV ECMO, what we should explore?
Hongling Zhang1,2, Zhengdong Liu2, Huaqing Shu1
1Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Journal of Intensive Care
|October 4, 2022
Summary
Prone positioning may benefit severe acute respiratory distress syndrome (ARDS) patients on venovenous extracorporeal membrane oxygenation (VV ECMO). Optimal strategies and effects require further investigation for improved ARDS management.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Extracorporeal Life Support
Background:
- Acute respiratory distress syndrome (ARDS) is a critical condition with high mortality, often requiring intensive care.
- Prone positioning improves outcomes in moderate to severe ARDS by leveraging physiological benefits.
- Venovenous extracorporeal membrane oxygenation (VV ECMO) is used for severe hypoxemia in ARDS.
Purpose of the Study:
- To review the controversial aspects of prone positioning in ARDS patients undergoing VV ECMO.
- To highlight unanswered questions and suggest future research directions for optimizing this combined therapy.
Main Methods:
- Discussion of potential effects of prone positioning on gas exchange, respiratory mechanics, and hemodynamics in ARDS patients on VV ECMO.
- Exploration of optimal strategies including indications, timing, duration, and frequency of prone positioning.
- Consideration of ARDS phenotypes and advanced monitoring (CT, ultrasound, EIT) for individualized therapy.
Main Results:
- The benefits of prone positioning and VV ECMO alone in severe ARDS are established.
- Significant questions remain regarding the combined use of prone positioning and VV ECMO.
- Potential benefits on gas exchange, mechanics, and outcomes are discussed but not fully clarified.
Conclusions:
- The precise effects of prone positioning in ARDS patients on VV ECMO are not yet fully understood.
- Developing an optimal, individualized strategy for prone positioning during VV ECMO is challenging and necessitates further research.
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