Research Of The Application Of Prone Position Ventilation In Children With Severe Pneumonia

ObjectivesTo explore the clinical effect of prone position ventilation in children with severe pneumonia,and the effects of mechanical ventilation in supine position and prone position on ventilation oxygenation function,pulmonary inflammation absorption,mechanical ventilation time,PICU hospitalization time and complications were compared.To determine whether prone position ventilation has clinical significance for children with severe pneumonia,and to provide reference for clinical application.MethodsA total of 120 children with severe pneumonia who were hospitalized in PICU of Xuzhou Children's Hospital from December 2018 to August 2019 were enrolled in this study.They were randomly divided into control group(60 cases)and observation group(60 cases).The patients in the control group were given routine nursing for mechanical ventilation patients with severe pneumonia,taking the routine supine position;the patients in the observation group were given prone position twice a day,three hours each time,the implementation method:kept prone position for 3 hours and then turn to supine position for 2 hours and then prone position for 3 hours,after treatment they were given supine position.The PaO2,PaCO2,oxygenation index(PaO2/FiO2),pulmonary inflammation absorption(chest X-ray)3 days and 7 days after treatment,mechanical ventilation time,PICU hospitalization time,incidence of ventilator-associated pneumonia(VAP)and stress injury were compared between the two groups.Results5 of the 120 patients included in the study were dropped out for different reasons,including 2 in the observation group and 3 in the control group.The study was completed in 115 patients,58 in the observation group and 57 in the control group.1.There was no significant difference in baseline data between the two groups before interventionThere was no significant difference in sex ratio,age,length,weight,heart rate and respiration at admission between the two groups(P>0.05);there was no significant difference in PaO2,PaCO2,PaO2/FiO2 after 30 minutes of mechanical ventilation between the two groups(P>0.05).The baseline data of the two groups were balanced and comparable.2.Comparison of PaO2,PaCO2 and PaO2/FiO2 at 0.5,1,2 and 3 days after admission between the two groupsThere was no significant difference in PaO2,PaCO2 and PaO2/FiO2 between the two groups at 0.5 days after admission,PaCO2 and PaO2/FiO2 between the two groups on admission day 1 also had no significant difference(P>0.05);PaO2 on admission day 1 had significant difference(P<0.05);With the prolongation of prone position ventilation time,the improvement of PaO2,PaCO2 and PaO2/FiO2 in the observation group was significantly better than that in the control group on admission day 2 and 3(P<0.05).3.Comparison of absorption of pulmonary inflammation between the two groupsThe results of chest X-ray reexamination after 3 days of treatment showed that 24 cases(41.38%)in observation group absorbed pulmonary inflammation completely or mostly,while 13 cases(22.81%)in control group.There was significant difference between the two groups(P<0.05).After 7 days of treatment,53 cases(91.38%)in observation group absorbed pulmonary inflammation completely or mostly,while 43 cases(75.44%)in control group.There was significant difference between the two groups(P<0.05).4.Comparison of mechanical ventilation time and PICU hospitalization time between the two groupsThe duration of mechanical ventilation in the observation group was(97.53±15.86)h,and in the control group was(109.58±22.93)h.There was significant difference in the duration of mechanical ventilation between the two groups(P<0.05).The hospitalization time of PICU in the observation group was(172.14±26.27)h,and in the control group was(186.11±29.84)h.The hospitalization time of PICU in the two groups had significant difference(P<0.05).5.Comparison of the incidence of VAP between the two groupsDuring the study period,1 case of VAP occurred in the observation group and 1 case in the control group.There was no statistical difference between the two groups(P>0.05).6.Comparison of the incidence of stress injury between the two groupsDuring the study period,one child in the observation group suffered from stress injury,while no child in the control group suffered from stress injury.There was no statistical difference between the two groups(P>0.05).Conclusions1.Compared with routine supine ventilation,prone position ventilation can improve the ventilation and oxygenation function of children with severe pneumonia,and promote the absorption of pulmonary inflammation.2.Compared with routine supine ventilation,prone position ventilation can shorten the duration of mechanical ventilation and PICU hospitalization in children with severe pneumonia.3.Compared with routine supine ventilation,prone position ventilation had no effect on the incidence of ventilator-associated pneumonia and stress injury in children with severe pneumonia.