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Korean J Crit Care Med > Volume 22(2); 2007 > Article
Korean Journal of Critical Care Medicine 2007;22(2): 71-76.
급성호흡곤란증후군 환자들에서 복와위에서 앙와위로 변경 후 나타난 동맥혈가스 변화와 생존과의 연관성
김미영ㆍ홍상범ㆍ임채만ㆍ고윤석
울산대학교 의과대학 서울아산병원 내과학교실
Relationship between the Changes of Arterial Blood Gas by Positioning from Prone to Supine and Patients' Survival in ARDS
Mi Young Kim, Sang Bum Hong, Chae Man Lim, Younsuck Koh
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. yskoh@amc.seoul.kr
ABSTRACT
BACKGROUND: Prone positioning has been adopted as a strategy to improve oxygenation in patients with refractory acute respiratory distress syndrome (ARDS). After returning to supine position, most of patients show arterial blood gas changes. However, the clinical implications have not been elucidated. This study was aimed to observe the relationship between the arterial blood gas changes followed by changing position from prone to supine and survival of ARDS. METHODS: We analyzed medical data of 53 ARDS patients, who showed improved arterial oxygenation (defined as the increase in PaO2/FiO2 by > or =20 mmHg within 8~12 hour after prone positioning) in a medical intensive care unit from January, 2000 to July, 2006. The patients were returned to supine position when they showed their PaO2/FiO2 > or =150 mmHg. We compared the arterial blood gas changes between the survivor and the nonsurvivor. RESULTS: The survivor has significant pH improvement after position change (the survivor 0.01+/-0.06 vs. the nonsurvivor -0.03+/-0.08; p=.03). The PaO2/FiO2 and FiO2 changes were not different between the survivor (14.44 +/-69.68 and -2.2+/-4.3, respectively) and the nonsurvivor (-7.17+/-83.94 and 1.8+/-6.0, respectively; p=.314 and .843). The patients whose PaO2/FiO2 were deteriorated had higher mortality without statistical significance (p=.305). The PaCO2 changes were not different between two groups (-0.05+/-11.46 vs. 3.47+/-17.62, p=.390). CONCLUSIONS: The early changes in pH differed significantly between the survivor and the nonsurvivor after returning patients to supine position from prone. Whether this marker can be a predictor of survival should be studied further.
Key Words: Acute respiratory distress syndrome; Blood gas analysis; Prone position; Survival
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