The effects of different prone ventilation strategies on mechanical power and respiratory mechanics in acute respiratory distress syndrome patients: a prospective, single-center observational study.

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a common pathological condition among critically ill patients that often requires mechanical ventilation support. However, mechanical ventilation increases the risk of ventilator-induced lung injury (VILI). Different prone ventilation strategies may have varying effects on mechanical power (MP) and respiratory mechanics. This study aimed to compare the effects of prone ventilation and lateral-prone ventilation on MP and respiratory mechanics in ARDS patients to assess the relative risks of VILI associated with these strategies.

Methods: This prospective, single-center observational study employed a randomized trial. One hundred and twenty-two patients with moderate-to-severe ARDS admitted to the Department of Critical Care Medicine at Lishui Central Hospital between December 2021 and April 2024 were enrolled in this study. Patients were randomly assigned to receive either prone or lateral-prone ventilation strategies. The primary outcomes included MP, driving pressure (DP), static lung compliance (Cstat), airway resistance (Raw), the oxygenation index [i.e., the oxygen saturation to fraction of inspired oxygen (SpO₂/FiO₂) ratio], the mortality rate, and the duration of the mechanical ventilation. Statistical analyses were performed to compare the effects of the two ventilation strategies on the respiratory mechanics and clinical outcomes.

Results: The baseline characteristics of the patients, such as age, gender, and body mass index, were comparable between the two groups. No significant differences were found between the groups in terms of the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score. No significant differences were observed in the SpO₂/FiO₂ ratio, mean arterial pressure (MAP), or Raw at different time points. However, MP differed significantly between the prone and lateral-prone groups. No significant differences were found between the two groups regarding heart rate (HR), MAP, and Cstat.

Conclusions: Compared to prone ventilation, lateral-prone ventilation significantly reduced MP in ARDS patients. The early adoption of lateral-prone ventilation may help mitigate the risk of VILI. This strategy holds clinical promise and warrants further validation and optimization.