Revista de Anestesiología Clínica: Acceso Abierto

Early prone ventilation in severe ARDS: case study and literature review.

Abstract

Manpreet Singh

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by radiological diffuse bilateral lung infiltration, decreased respiratory compliance and severe hypoxemia. The major goal in ARDS is correction of life threatening hypoxemia and concurrent improvement of respiratory mechanics. Mechanical ventilation is invariably required in this subset of patients with aim of providing optimum oxygenation and at the same time strategies to prevent ventilator-induced lung injury (VILI). While lung protective strategies remain the main stay of treatment, early prone ventilation plays a crucial role to improve ventilation perfusion mismatch.

Prone ventilation with or without neuromuscular blocking agents (NMBAs) are distinctly indicated in severe refractory ARDS to achieve better expansion of the dorsal lung regions with consequent improvement in oxygenation. However, prone positioning requires advance competence level for attending critical care physicians and nursing staff due to the inherent risk associated with positioning. We report the successful management of an adult mechanically ventilated patient having scrub typhus induced severe refractory ARDS, undergoing early prone ventilation in conjunction with recommended ventilation strategies