Details

Autor(en) / Beteiligte

• Frick, Anna Elisabeth
• Schiefer, Judith
• Maleczek, Mathias
• Schwarz, Stefan
• Benazzo, Alberto
• Rath, Anna
• Kulu, Askin
• Hritcu, Richard
• Faybik, Peter
• Schaden, Eva
• Jaksch, Peter
• Tschernko, Edda
• Frommlet, Florian
• Markstaller, Klaus
• Hoetzenecker, Konrad

Titel

The Effect of Prone Positioning After Lung Transplantation

Ist Teil von

• The Annals of thoracic surgery, 2024-05, Vol.117 (5), p.1045

Ort / Verlag

Netherlands

Erscheinungsjahr

2024

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Prone positioning has become a standard therapy in acute respiratory distress syndrome to improve oxygenation and decrease mortality. However, little is known about prone positioning in lung transplant recipients. This large, singe-center analysis investigated whether prone positioning improves gas exchange after lung transplantation. Clinical data of 583 patients were analyzed. Prone position was considered in case of impaired gas exchange Pao /fraction of oxygen in inhaled air (<250), signs of edema after lung transplantation, and/or evidence of reperfusion injury. Patients with hemodynamic instability or active bleeding were not proned. Impact of prone positioning (n = 165) on gas exchange, early outcome and survival were determined and compared with patients in supine positioning (n = 418). Patients in prone position were younger, more likely to have interstitial lung disease, and had a higher lung allocation score. Patients were proned for a median of 19 hours (interquartile range,15-26) hours). They had significantly lower Pao /fraction of oxygen in inhaled air (227 ± 96 vs 303 ± 127 mm Hg, P = .004), and lower lung compliance (24.8 ± 9.1 mL/mbar vs 29.8 ± 9.7 mL/mbar, P < .001) immediately after lung transplantation. Both values significantly improved after prone positioning for 24 hours (Pao /fraction of oxygen ratio: 331 ± 91 mm Hg; lung compliance: 31.7 ± 20.2 mL/mbar). Survival at 90 days was similar between the 2 groups (93% vs 96%, P = .105). Prone positioning led to a significant improvement in lung compliance and oxygenation after lung transplantation. Prospective studies are needed to confirm the benefit of prone positioning in lung transplantation.