| ORIGINAL ARTICLE |
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| Year : 2019 | Volume
: 9
| Issue : 4 | Page : 182-186 |
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Prone ventilation in H1N1 virus-associated severe acute respiratory distress syndrome: A case series
Jyoti Narayan Sahoo1, Mohan Gurjar2, Krantimaya Mohanty1, Kalpana Majhi1, G Sradhanjali1
1 Department of Critical Care Medicine, Sunshine Hospital, Bhubaneswar, Odisha, India
2 Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
Correspondence Address:
Dr. Jyoti Narayan Sahoo
Department of Critical Care Medicine, Sunshine Hospital, Bhubaneswar, Odisha
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/IJCIIS.IJCIIS_62_18
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Background: Management of H1N1 viral infection-associated acute respiratory distress syndrome (ARDS) has primarily been focused on lung protective ventilation strategies, despite that mortality remains high (up to 45%). Other measures to improve survival are prone position ventilation (PPV) and extracorporeal membrane oxygenation. There is scarcity of literature on the use of prone ventilation in H1N1-associated ARDS patients.
Methods: In this retrospective study, all adult patients admitted to medical intensive care unit (ICU) with H1N1 viral pneumonia having severe ARDS and requiring prone ventilation as a rescue therapy for severe hypoxemia were reviewed. The patients were considered to turn prone if PaO2/FiO2ratio was <100 cmH2O and PaCO2was >45 cmH2O; if no progressive improvement was seen in PaO2/FiO2over a period of 4 h, then patients were considered to turn back to supine. Measurements were obtained in supine (baseline) and PPV, after 30–60 min and then 4–6 hourly.
Results: Eleven adult patients with severe ARDS were ventilated in prone position. Their age range was 26–59 years. The worst PaO2/FiO2ratio range on the day of invasive ventilation was 48–100 (median 79). A total of 39 PPV sessions were done, with a range of 1–8 prone sessions per patient (median three sessions). Out of the 39 PPV sessions, PaO2/FiO2ratio and PaCO2responder were 38 (97.4%) and 27 (69.2%) sessions, respectively. The median ICU stay and mechanical ventilation days were 15 (range: 3–26) and 12 (range: 2–22) days, respectively. The common complication observed due to PPV was pressure ulcer. At ICU discharge, all except two patients survived.
Conclusion: PPV improves oxygenation when started early with adequate duration and should be considered in all severe ARDS cases secondary to H1N1 viral infection.
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