Association between ventilation-perfusion matching improvement during initial prone positioning and ICU mortality in patients with moderate to severe ARDS: a prospective two-center study.

IF 5.5 1区医学 Q1 CRITICAL CARE MEDICINE

Annals of Intensive Care Pub Date : 2025-05-21 DOI:10.1186/s13613-025-01489-1

Rui Wang, Wancong Wang, Xiao Tang, Zhenyuan Qi, Ting Li, Yalan Liu, Hongju Li, Jican Yan, Hua Yang, Wenrui Lyu, Zhaohong Li, Bing Sun, Guifen Gan

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引用次数: 0

Abstract

Background: Prone positioning (PP) is widely used in patients with moderate to severe acute respiratory distress syndrome (ARDS) to reduce mortality by mitigating the risk of ventilation-induced lung injury (VILI) and enhancing ventilation-perfusion (V/Q) matching. However, patient responses to PP are variable, and the relationship between V/Q matching improvement during PP and clinical outcomes remains unclear. This study aimed to test the hypothesis that improvements in V/Q matching 4 h within the first PP are associated with reduced intensive care unit (ICU) mortality.

Methods: In this two-center, prospective, observational study, regional ventilation and perfusion changes in patients with moderate to severe ARDS were evaluated using electrical impedance tomography (EIT) during the first PP session. Patients were categorized as responders or non-responders based on whether V/Q matching improved by ≥ 10% within 4 h of the first PP. The primary endpoint was ICU mortality, and the secondary endpoint was ventilator-free days at day 28.

Results: A total of 77 patients were included in the study, with 46 (59.7%) classified as responders and 31 (40.3%) as non-responders. EIT revealed significant improvements in V/Q matching during PP, primarily through reduced dorsal shunt and ventral dead space. These improvements were partially sustained after resupination. Responders showed significantly lower ICU mortality (28.3% vs. 51.6%; P = 0.038) and more ventilator-free days at day 28 (16 [range, 0-21] days vs. 9 [0-15] days; P = 0.024) than non-responders. Multivariate analysis confirmed enhanced V/Q matching as an independent protective factor against mortality (OR, 0.790; 95% CI, 0.681-0.917; P = 0.002).

Conclusions: Improvement in V/Q matching 4 h within the first PP is associated with lower ICU mortality in patients with moderate to severe ARDS. These findings underscore the importance of PP in ARDS management and highlight the potential of V/Q responsiveness in guiding individualized PP strategies.

Trial registration: ClinicalTrials.Gov: NCT05765760. Registered 28 February 2023.

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中至重度ARDS患者初始俯卧位通气灌注匹配改善与ICU死亡率之间的关系：一项前瞻性双中心研究

背景：俯卧位（俯卧位）被广泛应用于中重度急性呼吸窘迫综合征（ARDS）患者，通过减轻通气致肺损伤（VILI）风险和增强通气灌注（V/Q）匹配来降低死亡率。然而，患者对PP的反应是可变的，并且PP期间V/Q匹配改善与临床结果之间的关系尚不清楚。本研究旨在验证第一PP内4小时V/Q匹配的改善与重症监护病房（ICU）死亡率降低相关的假设。方法：在这项双中心、前瞻性、观察性研究中，使用电阻抗断层扫描（EIT）评估首次PP治疗期间中重度ARDS患者的局部通气和灌注变化。根据首次PP后4小时内V/Q匹配是否改善≥10%，将患者分为反应者或无反应者。主要终点是ICU死亡率，次要终点是第28天无呼吸机天数。结果：共纳入77例患者，其中46例（59.7%）为应答者，31例（40.3%）为无应答者。EIT显示，PP期间的V/Q匹配有显著改善，主要是通过减少背侧分流和腹侧死区。这些改善在复星后部分得到维持。应答者的ICU死亡率显著降低(28.3% vs. 51.6%；P = 0.038)，第28天无呼吸机天数较多(16[范围，0-21]天vs. 9[0-15]天；P = 0.024)。多因素分析证实，增强的V/Q匹配是预防死亡率的独立保护因素(OR, 0.790；95% ci, 0.681-0.917；p = 0.002)。结论：第一PP内4小时V/Q匹配的改善与中重度ARDS患者ICU死亡率降低相关。这些发现强调了肺活量在ARDS管理中的重要性，并强调了V/Q反应在指导个性化肺活量策略方面的潜力。试验注册：临床试验。政府:NCT05765760。2023年2月28日注册

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来源期刊

Annals of Intensive Care CRITICAL CARE MEDICINE-

CiteScore

14.20

自引率

3.70%

发文量

107

审稿时长

13 weeks

期刊介绍： Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.