Prone Positioning for Acute Respiratory Failure after PEA: An Initial Experience.

Background:  We retrospectively analyzed patients who underwent prone positioning (PP) for acute respiratory failure after pulmonary endarterectomy (PEA).

Methods:  A total of 125 patients underwent PEA and the outcome related to patients who underwent PP for acute respiratory failure after surgery was analyzed.

Results:  In all 13 patients (10%) underwent PP at the mean duration of 28.2 ± 10.6 hours after surgery and the mean prone time was 29.4 ± 9.8 hours. Compared with the pre-prone values, there was a significant improvement in the mean arterial oxygen to fraction of inspired oxygen ratio at the end of PP (119.4 ± 12.4 versus 202 ± 58.3) (p = 0.0002). Eight patients (61%) revealed a significant improvement in oxygenation with PP. Five patients who remained unresponsive underwent extracorporeal membrane oxygenation and four of them were weaned off successfully. In multivariate logistic stepwise analysis, the need for a moderate inotropy (odds ratio [OR]: 3.1) and low preoperative cardiac index (OR: 0.2) were independent predictors of PP. Under PP, the most common complication was ventilator-associated pneumonia (n = 9, 70%) and PP was found to be an independent predictor of ventilator-associated pneumonia (OR: 10.3). Early mortality was seen in three patients (23%, sepsis in two and adult respiratory distress syndrome in one).

Conclusion:  In the early care of acute respiratory failure following PTE, PP may be a feasible option, despite an increased risk of ventilator-associated pneumonia. More research involving a larger sample size is necessary.