Efficacy Of Prone Positionventilation Combined With Recruitment Manoeuvre On Patients Of Acute Respiratory

Background:Acute respiratory distress syndrome?ARDS?is a multiple serious and common disease which seriously threat to human health,is the most common acute respiratory failure,the mortality rate is as high as 40%[1-2],is the global treatment problems.The pathophysiological characteristics of ARDS is a large number of alveolar collapse and non-uniformity of lung lesions pulmonary fibrosis,recruitment manoeuvre?RM?make the collapsing alveolar opening and maintain alveolar opening,thereby improving oxygenation;but inappropriate RM may aggravate the non-uniformity of lung lesions,and it is not conducive to lung protection.The prone position ventilation combined with RM could reduce the non-uniformity of lung lesions in theory,which could improve oxygenation effectively in patients with ARDS,and play a protective role on lung tissue in patients with ARDS.Therefore,understanding the characteristics of RM and prone position ventilation,and the effects of prone position ventilation combined with RM on respiration and circulation in patients with ARDS,may provide a new strategy to improve the oxygenation for patients with ARDS.Objective:The changes of HR,CVP,MAP,PaO₂,PaO₂/Fi O₂,Pplat and Cst were compared between different mechanical ventilation mode?conventional mechanical ventilation and prone position mechanical ventilation?before RM and One hour,two hour,six hour after RM.To investigate the effects of prone position ventilation combined with RM on respiration and circulation in patients with ARDS.Methods:?1?Included in patients:Forty-two cases of patients who were treated for various reasons leading to ARDS and hospitalized in the Department of critical care medicine?ICU?of Suzhou Municipal Hospital,from January 2015 to June 2016,were involved according to the inclusion criteria and exclusion criteria.Forty-two patients with ARDS were divided into two groups:prone position ventilation combined with RM under conventional mechanical ventilation?prone position group?,prone position ventilation combined with RM by pressure-controlled ventilation?PCV?;conventional mechanical ventilation combined with RM?control group?,conventional mechanical ventilation combined with RM by PCV.?2?Monitoring indicators:Records the age,gender,APACHE II score,and other general information of the patients with ARDS;The changes of HR?S_PO₂?CVP?MAP?Pa O₂?Pa O₂/Fi O₂?Pplat?Cst were observed before RM and one hour,two hour,six hour after RM.Results:?1?One hour,two hour,six hour after RM,the improvements of PaO₂ and PaO₂/Fi O₂were significantly in prone position group and control group?P<0.05?.?2?One hour,two hour,six hour after RM,the improvement rate of PaO₂ and Pa O₂/Fi O₂ were more significantly in prone position group than those in control group?P<0.05?.?3?There was no statistical difference in Pplat?Cst before and after RM between both groups?p>0.05?.?4?One hour after RM,the HR and CVP in both groups were significantly higher than pre-RM?p<0.05?,and MAP in both groups were lower than pre-RM?p<0.05?;In both groups,there was no significant difference in HR,CVP and MAP at two hour and six hour after RM compared with pre-RM?p>0.05?.?5?There was no statistical difference in the change rate of HR?CVP and MAP between both groups at one hour,two hour,six hour after RM?P>0.05?.Conclusions:?Prone position ventilation combined with RM by PCV can effectively improve oxygenation in the patients with ARDS than those in control group.?Regardless of position,there was no significant difference in Pplat and Cst by conventional mechanical ventilation combined with RM in the patients with ARDS.?Regardless of position,the HR and CVP at one hour after RM in the patients with ARDS were significantly higher than pre-RM,and MAP at one hour after RM were lower than pre-RM,the HR,CVP,MAP at two hour and six hour after RM in the patients with ARDS were similared than pre-RM.?There was no significant difference in HR,CVP,MAP at one hour,two hour and six hour after RM between the different recruitment manoeuvre methods in the patients with ARDS.