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European Journal of Medical Research

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Open Access 01-12-2024 | Acute Respiratory Distress-Syndrome | Research

Prone positioning does not improve outcomes of intubated patients with pneumocystis pneumonia and moderate–severe acute respiratory distress syndrome: a single-center, retrospective, observational, cohort study

Authors: Zhen Wang, Yuyan Zhou, Min Zhu, Faping Wang, Yubei Zhou, He Yu, Fengming Luo

Published in: European Journal of Medical Research | Issue 1/2024

Abstract

Background

Pneumocystis pneumonia is an uncommon precipitant of acute respiratory distress syndrome and is associated with high mortality. Prone positioning ventilation has been proven to reduce mortality in patients with moderate–severe acute respiratory distress syndrome. We investigated the effect of prone positioning on oxygenation and mortality in intubated patients with pneumocystis pneumonia comorbid with moderate–severe acute respiratory distress syndrome.

Methods

In this single-center, retrospective, observational, cohort study, eligible patients were enrolled at West China Hospital of Sichuan University from January 1, 2017, to December 31, 2021. Data on demographics, clinical features, ventilation parameters, arterial blood gas, and outcomes were collected. Patients were assigned to the prone cohort or supine cohort according to whether they received prone positioning ventilation. The main outcome was 28-day mortality.

Findings

A total of 79 patients were included in the study. Sixty-three patients were enrolled in the prone cohort, and 16 patients were enrolled in the supine cohort. The 28-day mortality was 61.9% in the prone cohort and 68.8% in the supine cohort (P = 0.26), and 90-day mortality was 66.7% in the prone cohort and 68.8% in the supine cohort (P = 0.55). Patients in the supine cohort had fewer invasive mechanical ventilation days and more ventilator-free days. The incidence of complications was higher in the prone cohort than in the supine cohort.

Conclusions

In patients with pneumocystis pneumonia and moderate–severe acute respiratory distress syndrome, prone positioning did not decrease 28-day or 90-day mortality.

Trial registration ClinicalTrials.gov number, ChiCTR2200063889. Registered on 20 September 2022, https://www.chictr.org.cn/showproj.html?proj=174886.

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Weyant RB, Kabbani D, Doucette K, Lau C, Cervera C. Pneumocystis jirovecii: a review with a focus on prevention and treatment. Expert Opin Pharmacother. 2021;22(12):1579–92.CrossRefPubMed

Salzer HJF, Schäfer G, Hoenigl M, Günther G, Hoffmann C, Kalsdorf B, Alanio A, Lange C. Clinical, diagnostic, and treatment disparities between HIV-infected and non-HIV-infected immunocompromised patients with Pneumocystis jirovecii pneumonia. Respiration. 2018;96(1):52–65.CrossRefPubMed

White PL, Backx M, Barnes RA. Diagnosis and management of Pneumocystis jirovecii infection. Expert Rev Anti Infect Ther. 2017;15(5):435–47.CrossRefPubMed

Kovacs JA, Masur H. Evolving health effects of Pneumocystis: one hundred years of progress in diagnosis and treatment. JAMA. 2009;301(24):2578–85.CrossRefPubMed

Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome. Lancet. 2021;398(10300):622–37.CrossRefPubMedPubMedCentral

Roux A, Canet E, Valade S, et al. Pneumocystis jirovecii pneumonia in patients with or without AIDS. France Emerg Infect Dis. 2014;20(9):1490–7.CrossRefPubMed

Kumagai S, Arita M, Koyama T, Kumazawa T, Inoue D, Nakagawa A, Kaji Y, Furuta K, Fukui M, Tomii K, Taguchi Y, Tomioka H, Ishida T. Prognostic significance of crazy paving ground grass opacities in non-HIV Pneumocystis jirovecii pneumonia: an observational cohort study. BMC Pulm Med. 2019;19(1):47.CrossRefPubMedPubMedCentral

Hsu JM, Hass A, Gingras MA, Chong J, Costiniuk C, Ezer N, Fraser RS, McDonald EG, Lee TC. Radiographic features in investigated for Pneumocystis jirovecii pneumonia: a nested case-control study. BMC Infect Dis. 2020;20(1):492.CrossRefPubMedPubMedCentral

Hardak E, Brook O, Yigla M. Radiological features of Pneumocystis jirovecii Pneumonia in immunocompromised patients with and without AIDS. Lung. 2010;188(2):159–63.CrossRefPubMed

10.

Mu XD, Jia P, Gao L, Su L, Zhang C, Wang RG, Wang GF. Relationship between radiological stages and prognoses of Pneumocystis pneumonia in non-AIDS immunocompromised patients. Chin Med J (Engl). 2016;129(17):2020–5.CrossRefPubMed

11.

Fan E, Del Sorbo L, Goligher EC, American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195(9):1253–63.CrossRefPubMed

12.

Galiatsou E, Kostanti E, Svarna E, Kitsakos A, Koulouras V, Efremidis SC, Nakos G. Prone position augments recruitment and prevents alveolar overinflation in acute lung injury. Am J Respir Crit Care Med. 2006;174(2):187–97.CrossRefPubMed

13.

Guerin C, Baboi L, Richard JC. Mechanisms of the effects of prone positioning in acute respiratory distress syndrome. Intensive Care Med. 2014;40(11):1634–42.CrossRefPubMed

14.

Wang YX, Zhong M, Dong MH, et al. Prone positioning improves ventilation-perfusion matching assessed by electrical impedance tomography in patients with ARDS: a prospective physiological study. Crit Care. 2022;26(1):154.CrossRefPubMedPubMedCentral

15.

Guérin C, Reignier J, Richard JC, PROSEVA Study Group, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159–68.CrossRefPubMed

16.

Griffiths MJD, McAuley DF, Perkins GD, Barrett N, Blackwood B, Boyle A, et al. Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respir Res. 2019;6(1): e000420.CrossRefPubMedPubMedCentral

17.

Papazian L, Aubron C, Brochard L, Chiche JD, Combes A, Dreyfuss D, Forel JM, Guérin C, Jaber S, Mekontso-Dessap A, Mercat A, Richard JC, Roux D, Vieillard-Baron A, Faure H. Formal guidelines: management of acute respiratory distress syndrome. Ann Intensive Care. 2019;9(1):69.CrossRefPubMedPubMedCentral

18.

Papazian L, Forel JM, Gacouin A, ACURASYS Study Investigators, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107–16.CrossRefPubMed

19.

Calfee CS, Janz DR, Bernard GR, May AK, Kangelaris KN, Matthay MA, Ware LB. Distinct molecular phenotypes of direct vs indirect ARDS in single-center and multicenter studies. Chest. 2015;147(6):1539–48.CrossRefPubMed

20.

Calfee CS, Delucchi KL, Sinha P, Matthay MA, Hackett J, Shankar-Hari M, McDowell C, Laffey JG, O’Kane CM, McAuley DF, Irish Critical Care Trials Group. Acute respiratory distress syndrome subphenotypes and differential response to simvastatin: secondary analysis of a randomised controlled trial. Lancet Respir Med. 2018;6(9):691–8.CrossRefPubMedPubMedCentral

21.

Jabaudon M, Blondonnet R, Lutz J, Roszyk L, Bouvier D, Guérin R, Perbet S, Cayot S, Godet T, Blanchon L, Bazin JE, Futier E, Sapin V, Constantin JM. Net alveolar fluid clearance is associated with lung morphology phenotypes in acute respiratory distress syndrome. Anaesth Crit Care Pain Med. 2016;35(2):81–6.CrossRefPubMed

22.

Musch G, Layfield JD, Harris RS, Melo MF, Winkler T, Callahan RJ, Fischman AJ, Venegas JG. Topographical distribution of pulmonary perfusion and ventilation, assessed by PET in supine and prone humans. J Appl Physiol (1985). 2002;93(5):1841–51.CrossRefPubMed

23.

Scholten EL, Beitler JR, Prisk GK, Malhotra A. Treatment of ARDS with prone positioning. Chest. 2017;151(1):215–24.CrossRefPubMed

24.

Puybasset L, Cluzel P, Gusman P, Grenier P, Preteux F, Rouby JJ. Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. CT Scan ARDS Study Group. Intensive Care Med. 2000;26(7):857–69.CrossRefPubMed

25.

Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354(17):1775–86.CrossRefPubMed

26.

Constantin JM, Jabaudon M, Lefrant JY, AZUREA Network, et al. Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France (the LIVE study): a multicentre, single-blind, randomised controlled trial. Lancet Respir Med. 2019;7(10):870–80.CrossRefPubMed

27.

Coppola S, Pozzi T, Gurgitano M, Liguori A, Duka E, Bichi F, Ciabattoni A, Chiumello D. Radiological pattern in ARDS patients: partitioned respiratory mechanics, gas exchange and lung recruitability. Ann Intensive Care. 2021;11(1):78.CrossRefPubMedPubMedCentral

28.

Cavalcanti AB, Suzumura ÉA, Laranjeira LN, Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2017;318(14):1335–45.CrossRefPubMedPubMedCentral

29.

Grasselli G, Calfee CS, Camporota L, European Society of Intensive Care Medicine Taskforce on ARDS, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. 2023;49(7):727–59.CrossRefPubMedPubMedCentral

30.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–7.CrossRef

Title: Prone positioning does not improve outcomes of intubated patients with pneumocystis pneumonia and moderate–severe acute respiratory distress syndrome: a single-center, retrospective, observational, cohort study
Authors: Zhen Wang
Yuyan Zhou
Min Zhu
Faping Wang
Yubei Zhou
He Yu
Fengming Luo
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Acute Respiratory Distress-Syndrome
Pneumonia
Published in: European Journal of Medical Research / Issue 1/2024
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-024-01868-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prone positioning does not improve outcomes of intubated patients with pneumocystis pneumonia and moderate–severe acute respiratory distress syndrome: a single-center, retrospective, observational, cohort study

Abstract

Background

Methods

Findings

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Findings

Conclusions

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