Research Of The Application Of Prone Position Ventilation In Patients With ARDS After Aortic Dissection

Objective:A retrospective cohort study was conducted to analyze the effect of prone position ventilation（PPV）in patients with acute respiratory distress syndrome（ARDS）after aortic dissection（AD）,comparing the supine position and prone position of two different postures of patients ventilation and oxygenation,mechanical ventilation time and ICU length of hospital stay and complications,to determine prone position ventilation on postoperative patients complicated with ARDS aortic dissection is of clinical significance,to provide reference for clinical application;to provide theoretical guidance and practical significance for clinical nursing staff to evaluate patients and provide targeted intervention;to sum up the experience and lessons,improve the cognition and treatment level of medical workers to this disease,and the prognosis of AD patients can be improved effectively.Methods:A retrospective cohort study was used to collect the data of patients with ARDS after aortic dissection who were admitted to the intensive Care Department of a Grade A hospital in Shanxi Province from February 2017 to February 2019.Seventy-four patients meeting the inclusion criteria were selected and divided into the prone position group（n=37）and the supine position group（n=37）according to whether they were prone position ventilation.The supine position group received routine decubial position and nursing,and the prone position group received PPV and routine nursing.The p H,oxygenation index（Pa O₂/Fi O₂）,Pa O₂（partial pressure of arterial blood oxygen）and Pa CO₂（partial pressure of arterial blood carbon dioxide）of the two groups were analyzed at 2h,6h,12h and 72h after ARDS,and ultimately mechanical ventilation time,duration of ICU stay changes in the incidence of stress injuries in both groups.Results:After statistical analysis,after t test and Chi square test,there was no statistical significance in the comparison of general data between the two groups（P>0.05）,indicating comparability.Before ventilation,Pa CO₂was（55.26±10.08）mm Hg in the prone position group and（51.11±8.40）mm Hg in the supine position group,and there was no significant difference between the two groups（P>0.05）.Pa CO₂index of the supine position group and the prone position group decreased 2h after ventilation compared with that before,but P>0.05,the difference between the two groups was not statistically significant.The Pa CO₂index of the prone position group was（45.06±3.81）mm Hg,（41.14±3.15）mm Hg,（40.94±2.88）mm Hg at 6h,12h and 72h after prone position ventilation,respectively.The conventional decubitus position in the supine position group was（49.58±6.93）mm Hg,（49.05±5.39）mm Hg,（48.98±4.84）mm Hg,respectively,and the difference between the two groups was statistically significant（P<0.05）.Repeated measures ANOVA showed that Pa CO2 indicators of the two groups had statistically significant differences in the main effect of intervention,main effect of time and interaction effect（P<0.001）.Before ventilation,Pa O₂was（68.75±7.95）mm Hg in the prone position group and（68.55±7.36）mm Hg in the supine position group,and there was no significant difference between the two groups（P>0.05）.Pa O₂indexes of the prone position group at2h,6h,12h and 72h after ventilation were（78.71±8.09）mm Hg,（93.36±7.38）mm Hg,（109.01±8.55）mm Hg,（187.68±5.49）mm Hg,respectively.The Pa O₂of conventional decubed position in the supine position group were（69.04±7.16）mm Hg,（70.16±6.99）mm Hg,（69.44±5.93）mm Hg,（68.58±6.25）mm Hg,respectively.PO₂index in both groups was improved compared with that before.The prone position group had more significant changes than the supine position group（P<0.05）.Repeated measures ANOVA showed that Pa O₂indicators of the two groups had statistically significant differences in the main effect of intervention,main effect of time and interaction effect（P<0.001）.Before ventilation,the p H value of the prone position group was（7.31±0.07）,and that of the supine position group was（7.32±0.06）,and there was no statistical significance between the two groups（P>0.05）.The p H values of prone position group at 2h,6h,12h and 72h after ventilation were（7.37±0.05）,（7.43±0.03）,（7.47±0.35）and（7.35±0.05）,respectively.The p H values of the supine position group were（7.32±0.06）,（7.33±0.06）,（7.34±0.55）and（7.46±0.02）,respectively.The p H values in the two groups were improved compared with the previous,and the changes in the prone position group were more significant than those in the supine position group with statistical significance（P<0.05）.Repeated measure ANOVA showed that there were statistically significant differences in the main effect,time main effect and interaction effect of p H value between the two groups（P<0.001）.Before ventilation,the P/F value was（114.68±13.29）mm Hg in the prone position group and（114.27±12.26）mm Hg in the supine position group,and there was no statistical significance between the two groups（P>0.05）.The P/F of the prone position group before and after prone position ventilation at 2h,6h,12h and 72h were（131.24±13.54）mm Hg,（155.57±12.28）mm Hg,（181.68±14.19）mm Hg and（312.73±9.08）mm Hg,respectively.The conventional supine position group was（115.06±11.94）mm Hg,（116.94±11.65）mm Hg,（115.73±9.8）mm Hg and（114.30±10.41）mm Hg,respectively.The P/F index in the two groups were improved compared with that in the previous group,and the change in the prone position group was more obvious than that in the supine position group,with statistical significance（P<0.05）.Repeated measure ANOVA showed that the P/F index of the two groups had statistical significance in the main effect of intervention,the main effect of time,and the interaction effect（P<0.001）.The duration of mechanical ventilation in the prone position group was（4.92±1.36）days,less than that in the supine position group（7.16±2.13）days,and the length of ICU stay was（6.59±1.36）days,less than that in the supine position group（9.00±2.16）days,with statistically significant differences（P<0.001）.In terms of the occurrence of stress injury,there was no case of stress injury in the two groups.Conclusion:1.Compared with conventional supine ventilation,prone position ventilation is beneficial to improve ventilation and oxygenation function of ARDS after aortic dissection,and effectively improve arterial blood gas indicators.2.Prone position ventilation is associated with shorter mechanical ventilation time and shorter ICU stay than conventional supine ventilation.3.Compared with conventional supine ventilation,prone position ventilation had no effect on the incidence of pressure injury in ARDS patients after aortic dissection.