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Intensive Care Medicine

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01-02-2012 | Original

Long-term outcomes in survivors of acute respiratory distress syndrome ventilated in supine or prone position

Authors: D. Chiumello, P. Taccone, V. Berto, A. Marino, G. Migliara, M. Lazzerini, L. Gattinoni

Published in: Intensive Care Medicine | Issue 2/2012

Abstract

Purpose

The aim of this study is to examine long-term pulmonary function and quality of life in survivors of acute respiratory distress syndrome (ARDS) previously enrolled in a randomized multicenter trial testing prone compared with supine positioning (PSII study) at five Italian centers.

Design

Observational prospective study.

Subjects and measurements

Pulmonary function [spirometric test, gas exchange, carbon monoxide diffusion capacity (DLCO)], high-resolution computed tomography (CT) scan, and health-related quality of life [Short Form-36 (SF-36) and St. George’s Respiratory Questionnaire] were evaluated at 12 months.

Results

Twenty-six patients (13 in each group, mean age 54.1 ± 2.8 years, body mass index 24.5 ± 1.4 kg/m², PaO₂/FiO₂ 117 ± 49 mmHg) were evaluated. There were no significant differences in demographic data, illness severity, or outcome between the prone and supine groups. The overall survival rate was 40%. Pulmonary function was in the normal range without any differences between the two groups. Quantitative lung CT scan analysis showed similar amounts for not aerated (8.1 ± 3.2% versus 7.3 ± 3.4%), poorly aerated (15.3 ± 3.6% versus 17.1 ± 4.9%), and well-aerated (64.0% ± 8.4 versus 70.2 ± 8.4%) lung regions, while overaerated lung region was slightly higher in the prone compared with the supine group (12.5 ± 6.5% versus 5.3 ± 5.5%). Health-related quality of life was similar to in healthy population. However, these patients showed reduction in daily activity specifically due to pulmonary disease as measured by the St. George’s Respiratory Questionnaire.

Conclusions

No differences in pulmonary function or quality of life were observed in this small group of ARDS survivor patients treated in prone versus supine position.

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Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2:319–323PubMedCrossRef

Gattinoni L, Carlesso E, Cadringher P, Valenza F, Vagginelli F, Chiumello D (2003) Physical and biological triggers of ventilator-induced lung injury and its prevention. Eur Respir J Suppl 47:15s–25sPubMedCrossRef

Ferguson ND, Frutos-Vivar F, Esteban A, Anzueto A, Alia I, Brower RG, Stewart TE, Apezteguia C, Gonzalez M, Soto L, Abroug F, Brochard L (2005) Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome. Crit Care Med 33:21–30PubMedCrossRef

Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693PubMedCrossRef

Angus DC, Musthafa AA, Clermont G, Griffin MF, Linde-Zwirble WT, Dremsizov TT, Pinsky MR (2001) Quality-adjusted survival in the first year after the acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1389–1394PubMed

Cheung AM, Tansey CM, Tomlinson G, Diaz-Granados N, Matte A, Barr A, Mehta S, Mazer CD, Guest CB, Stewart TE, Al Saidi F, Cooper AB, Cook D, Slutsky AS, Herridge MS (2006) Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 174:538–544PubMedCrossRef

Ghio AJ, Elliott CG, Crapo RO, Berlin SL, Jensen RL (1989) Impairment after adult respiratory distress syndrome. An evaluation based on American Thoracic Society recommendations. Am Rev Respir Dis 139:1158–1162PubMed

Heyland DK, Groll D, Caeser M (2005) Survivors of acute respiratory distress syndrome: relationship between pulmonary dysfunction and long-term health-related quality of life. Crit Care Med 33:1549–1556PubMedCrossRef

Linden VB, Lidegran MK, Frisen G, Dahlgren P, Frenckner BP, Larsen F (2009) ECMO in ARDS: a long-term follow-up study regarding pulmonary morphology and function and health-related quality of life. Acta Anaesthesiol Scand 53:489–495PubMedCrossRef

10.

Orme J Jr, Romney JS, Hopkins RO, Pope D, Chan KJ, Thomsen G, Crapo RO, Weaver LK (2003) Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 167:690–694PubMedCrossRef

11.

Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP (1999) Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 281:354–360PubMedCrossRef

12.

Dowdy DW, Eid MP, Dennison CR, Mendez-Tellez PA, Herridge MS, Guallar E, Pronovost PJ, Needham DM (2006) Quality of life after acute respiratory distress syndrome: a meta-analysis. Intensive Care Med 32:1115–1124PubMedCrossRef

13.

Schelling G, Stoll C, Vogelmeier C, Hummel T, Behr J, Kapfhammer HP, Rothenhausler HB, Haller M, Durst K, Krauseneck T, Briegel J (2000) Pulmonary function and health-related quality of life in a sample of long-term survivors of the acute respiratory distress syndrome. Intensive Care Med 26:1304–1311PubMedCrossRef

14.

Gattinoni L, Vagginelli F, Carlesso E, Taccone P, Conte V, Chiumello D, Valenza F, Caironi P, Pesenti A (2003) Decrease in PaCO₂ with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med 31:2727–2733PubMedCrossRef

15.

Valenza F, Guglielmi M, Maffioletti M, Tedesco C, Maccagni P, Fossali T, Aletti G, Porro GA, Irace M, Carlesso E, Carboni N, Lazzerini M, Gattinoni L (2005) Prone position delays the progression of ventilator-induced lung injury in rats: does lung strain distribution play a role? Crit Care Med 33:361–367PubMedCrossRef

16.

Mentzelopoulos SD, Roussos C, Zakynthinos SG (2005) Prone position reduces lung stress and strain in severe acute respiratory distress syndrome. Eur Respir J 25:534–544PubMedCrossRef

17.

Galiatsou E, Kostanti E, Svarna E, Kitsakos A, Koulouras V, Efremidis SC, Nakos G (2006) Prone position augments recruitment and prevents alveolar overinflation in acute lung injury. Am J Respir Crit Care Med 174:187–197PubMedCrossRef

18.

Broccard AF, Shapiro RS, Schmitz LL, Ravenscraft SA, Marini JJ (1997) Influence of prone position on the extent and distribution of lung injury in a high tidal volume oleic acid model of acute respiratory distress syndrome. Crit Care Med 25:16–27PubMedCrossRef

19.

Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di Giulio P, Fumagalli R, Pelosi P, Brazzi L, Latini R (2001) Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 345:568–573PubMedCrossRef

20.

Guerin C, Gaillard S, Lemasson S, Ayzac L, Girard R, Beuret P, Palmier B, Le QV, Sirodot M, Rosselli S, Cadiergue V, Sainty JM, Barbe P, Combourieu E, Debatty D, Rouffineau J, Ezingeard E, Millet O, Guelon D, Rodriguez L, Martin O, Renault A, Sibille JP, Kaidomar M (2004) Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial. JAMA 292:2379–2387PubMedCrossRef

21.

Mancebo J, Fernandez R, Blanch L, Rialp G, Gordo F, Ferrer M, Rodriguez F, Garro P, Ricart P, Vallverdu I, Gich I, Castano J, Saura P, Dominguez G, Bonet A, Albert RK (2006) A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med 173:1233–1239PubMedCrossRef

22.

Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, Caspani L, Raimondi F, Bordone G, Iapichino G, Mancebo J, Guerin C, Ayzac L, Blanch L, Fumagalli R, Tognoni G, Gattinoni L (2009) Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA 302:1977–1984PubMedCrossRef

23.

Gattinoni L, Carlesso E, Taccone P, Polli F, Guerin C, Mancebo J (2010) Prone positioning improves survival in severe ARDS: a pathophysiologic review and individual patient meta-analysis. Minerva Anestesiol 76:448–454PubMed

24.

Weisman IM, Zeballos RJ (2001) Clinical exercise testing. Clin Chest Med 22:679–701PubMedCrossRef

25.

McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD (1994) The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 32:40–66PubMedCrossRef

26.

Jones PW, Quirk FH, Baveystock CM (1991) The St. George’s Respiratory Questionnaire. Respir Med 85:25–31 Suppl BPubMedCrossRef

27.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRef

28.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710PubMedCrossRef

29.

Report working party (1983) Standardized lung function testing. Bull Eur Physiopathol Respir 19(Suppl 5):1–95

30.

Ware JE, Snow KK, Kosinski M, Gandek B (1993) SF-36 health survey: manual and interpretation guide. Boston: Mass: The Health Institute Med Care 30:473–483

31.

Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G (2006) Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 354:1775–1786PubMedCrossRef

32.

Gattinoni L, Caironi P, Pelosi P, Goodman LR (2001) What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 164:1701–1711PubMed

33.

Fallon MB, Abrams GA (2000) Pulmonary dysfunction in chronic liver disease. Hepatology 32:859–865PubMedCrossRef

34.

Brower RG, Morris A, MacIntyre N, Matthay MA, Hayden D, Thompson T, Clemmer T, Lanken PN, Schoenfeld D (2003) Effects of recruitment manoeuvres in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure. Crit Care Med 31:2592–2597PubMedCrossRef

35.

The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301-1308

36.

Brun-Buisson C, Minelli C, Bertolini G, Brazzi L, Pimentel J, Lewandowski K, Bion J, Romand JA, Villar J, Thorsteinsson A, Damas P, Armaganidis A, Lemaire F (2004) Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med 30:51–61PubMedCrossRef

37.

Davidson TA, Rubenfeld GD, Caldwell ES, Hudson LD, Steinberg KP (1999) The effect of acute respiratory distress syndrome on long-term survival. Am J Respir Crit Care Med 160:1838–1842PubMed

38.

(1994) Predicting outcome in ICU patients. 2nd European Consensus Conference in Intensive Care Medicine. Intensive Care Med 20:390-397

39.

McHugh LG, Milberg JA, Whitcomb ME, Schoene RB, Maunder RJ, Hudson LD (1994) Recovery of function in survivors of the acute respiratory distress syndrome. Am J Respir Crit Care Med 150:90–94PubMed

40.

Klein JJ, van Haeringen JR, Sluiter HJ, Holloway R, Peset R (1976) Pulmonary function after recovery from the adult respiratory distress syndrome. Chest 69:350–355PubMedCrossRef

41.

Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, Brochard L, Richard JC, Lamontagne F, Bhatnagar N, Stewart TE, Guyatt G (2010) Higher versus lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA 303:865–873PubMedCrossRef

42.

Cesana BM, Antonelli P, Chiumello D, Gattinoni L (2010) Positive end-expiratory pressure, prone positioning, and activated protein C: a critical review of meta-analyses. Minerva Anestesiol 76:929–936PubMed

43.

Peters JI, Bell RC, Prihoda TJ, Harris G, Andrews C, Johanson WG (1989) Clinical determinants of abnormalities in pulmonary functions in survivors of the adult respiratory distress syndrome. Am Rev Respir Dis 139:1163–1168PubMed

44.

Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM (1982) Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 284:1607–1608CrossRef

45.

Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, Berman LB (1985) The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 132:919–923PubMed

46.

Desai SR, Wells AU, Rubens MB, Evans TW, Hansell DM (1999) Acute respiratory distress syndrome: CT abnormalities at long-term follow-up. Radiology 210:29–35PubMed

47.

Kim SJ, Oh BJ, Lee JS, Lim CM, Shim TS, Lee SD, Kim WS, Kim DS, Kim WD, Koh Y (2004) Recovery from lung injury in survivors of acute respiratory distress syndrome: difference between pulmonary and extrapulmonary subtypes. Intensive Care Med 30:1960–1963PubMedCrossRef

48.

Nobauer-Huhmann IM, Eibenberger K, Schaefer-Prokop C, Steltzer H, Schlick W, Strasser K, Fridrich P, Herold CJ (2001) Changes in lung parenchyma after acute respiratory distress syndrome (ARDS): assessment with high-resolution computed tomography. Eur Radiol 11:2436–2443PubMedCrossRef

49.

Collins JF, Smith JD, Coalson JJ, Johanson WG Jr (1984) Variability in lung collagen amounts after prolonged support of acute respiratory failure. Chest 85:641–646PubMedCrossRef

50.

Pratt PC, Vollmer RT, Shelburne JD, Crapo JD (1979) Pulmonary morphology in a multihospital collaborative extracorporeal membrane oxygenation project. I. Light microscopy. Am J Pathol 95:191–214PubMed

51.

Heyland DK, Guyatt G, Cook DJ, Meade M, Juniper E, Cronin L, Gafni A (1998) Frequency and methodologic rigor of quality-of-life assessments in the critical care literature. Crit Care Med 26:591–598PubMedCrossRef

52.

Chrispin PS, Scotton H, Rogers J, Lloyd D, Ridley SA (1997) Short form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire. Anaesthesia 52:15–23PubMedCrossRef

53.

Apolone G, Mosconi P (1998) The Italian SF-36 Health Survey: translation, validation and norming. J Clin Epidemiol 51:1025–1036PubMedCrossRef

54.

Alonso J, Anto JM, Gonzalez M, Fiz JA, Izquierdo J, Morera J (1992) Measurement of general health status of non-oxygen-dependent chronic obstructive pulmonary disease patients. Med Care 30:MS125–MS135PubMedCrossRef

55.

Mahler DA, Matthay RA, Snyder PE, Wells CK, Loke J (1985) Sustained-release theophylline reduces dyspnea in nonreversible obstructive airway disease. Am Rev Respir Dis 131:22–25PubMed

Title: Long-term outcomes in survivors of acute respiratory distress syndrome ventilated in supine or prone position
Authors: D. Chiumello
P. Taccone
V. Berto
A. Marino
G. Migliara
M. Lazzerini
L. Gattinoni
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2445-4

At a glance: The STEP trials

Springer Medicine

Long-term outcomes in survivors of acute respiratory distress syndrome ventilated in supine or prone position

Abstract

Purpose

Design

Subjects and measurements

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Design

Subjects and measurements

Results

Conclusions

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