Feasibility and effectiveness of prone position ventilation technique for postoperative acute lung injury in infants with congenital heart disease: study protocol for a prospective randomized study

Yu-Lu Xu, Ya-Ping Mi, Meng-Xin Zhu, Yue-Hong Ren, Wei-Juan Gong, Wei-Jia Fu, Hui-Mei Wang, Lan Ye, Yin Wang, Xiao-Yan Zhou, Yan Chen, Yan-Yan Chen, Li-Qiong Gu, Ying Gu, Bing Jia, Jing Hu, Xiao-Jing Hu, Yu-Lu Xu, Ya-Ping Mi, Meng-Xin Zhu, Yue-Hong Ren, Wei-Juan Gong, Wei-Jia Fu, Hui-Mei Wang, Lan Ye, Yin Wang, Xiao-Yan Zhou, Yan Chen, Yan-Yan Chen, Li-Qiong Gu, Ying Gu, Bing Jia, Jing Hu, Xiao-Jing Hu

Abstract

Background: Prone position ventilation is a widely used lung protection ventilation strategy. The strategy is more convenient to implement in children compared to adults. Due to the precise mechanism of improving oxygenation function, development of pediatric prone ventilation technology has been largely focused on children with acute respiratory distress syndrome. There is a paucity of high-quality studies investigating the effects of prone position ventilation after pediatric cardiac surgery. The purpose of this study is to evaluate the feasibility and effectiveness of prone position ventilation in infants who develop postoperative acute lung injury after surgery for congenital heart disease.

Methods: A single-center, randomized controlled trial of pediatric patients with acute lung injury after surgery for congenital heart disease who will receive prone position ventilation or usual care (control group). A total of 68 children will be enrolled according to the inclusion criteria. The main outcome measures will be lung compliance and oxygenation index. The secondary outcomes will be duration of mechanical ventilation, length of stay in cardiac intensive care unit, reintubation rate, and complication rate.

Discussion: This study will investigate the feasibility and effectiveness of prone position ventilation techniques in children who develop postoperative acute lung injury after surgery for congenital heart disease. The results may help inform strategies to improve airway management after surgery for congenital heart disease.

Trial registration: ClinicalTrials.gov NCT04607993 . Initially registered on 29 October 2020.

Keywords: Congenital heart disease; Pediatric; Prone position ventilation.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart providing an overview of important trial steps. First, understand the research situation and methods of this study at home and abroad through the literature, and then conduct a pre-test, correct the research deviation through the pre-test, and randomly group according to the allowance standard, determine the intervention group and the control group, and conduct data collection. Entry and statistical analysis

References

    1. Sud S, Friedrich JO, Adhikari NK, Taccone P, Mancebo J, Polli F, et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ. 2014;186(10):E381–E390. doi: 10.1503/cmaj.140081.
    1. Rowan CM, Am J. Early Use of Adjunctive Therapies for Pediatric Acute Respiratory Distress Syndrome: A PARDIE Study. Respir Crit Care Med. 2020;201(11):1389–1397. doi: 10.1164/rccm.201909-1807OC.
    1. Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, et al. Prone position for acute respiratory distress syndrome. a systematic review and meta-analysis. Ann Am Thorac Soc. 2017;14(Supplement_4):S280–S2s8. doi: 10.1513/AnnalsATS.201704-343OT.
    1. Cornejo RA, Díaz JC, Tobar EA, Bruhn AR, Ramos CA, González RA, Repetto CA, Romero CM, Gálvez LR, Llanos O, Arellano DH, Neira WR, Díaz GA, Zamorano AJ, Pereira GL. Effects of prone positioning on lung protection in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2013;188(4):440–448. doi: 10.1164/rccm.201207-1279OC.
    1. Gouna G, Rakza T, Kuissi E, Pennaforte T, Mur S, Storme L. Positioning effects on lung function and breathing pattern in premature newborns. J Pediatr. 2013;162:1133–7, 7.e1. doi: 10.1016/j.jpeds.2012.11.036.
    1. Gillies D, Wells D, Bhandari AP. Positioning for acute respiratory distress in hospitalised infants and children. Cochrane Database Syst Rev. 2012;2012:Cd003645.
    1. van der Burg PS, Miedema M, de Jongh FH, Frerichs I, van Kaam AH. Changes in lung volume and ventilation following transition from invasive to noninvasive respiratory support and prone positioning in preterm infants. Pediatr Res. 2015;77(3):484–488. doi: 10.1038/pr.2014.201.
    1. Puybasset L, Cluzel P, Chao N, Slutsky AS, Coriat P, Rouby JJ. A computed tomography scan assessment of regional lung volume in acute lung injury. The CT Scan ARDS Study Group. Am J Respir Crit Care Med. 1998;158(5):1644–1655. doi: 10.1164/ajrccm.158.5.9802003.
    1. Wu TW, Lien RI, Seri I, Noori S. Changes in cardiac output and cerebral oxygenation during prone and supine sleep positioning in healthy term infants. Arch Dis Child Fetal Neonatal Ed. 2017;102(6):F483–F4f9. doi: 10.1136/archdischild-2016-311769.
    1. Yin T, Yuh YS, Liaw JJ, Chen YY, Wang KW. Semi-prone position can influence variability in respiratory rate of premature infants using nasal CPAP. J Pediatr Nurs. 2016;31(2):e167–e174. doi: 10.1016/j.pedn.2015.10.014.
    1. Jian L, YanSong N. Cause analysis and treatment of postoperative atelectasis in infants with congenital heart disease. J Pract Med. 2006;23:61–62.
    1. LiJuan Y, LiYing G. Clinical nursing experience of 40 infants and young children with prone position ventilation after cardiac surgery. Shandong Med. 2007;47:35–36.
    1. Fineman LD, LaBrecque MA, Shih MC, Curley MA. Prone positioning can be safely performed in critically ill infants and children. Pediatr Crit Care Med. 2006;7(5):413–422. doi: 10.1097/01.PCC.0000235263.86365.B3.
    1. Eremenko AA, Egorov VM, Levikov DI. Results of the treatment of cardiac surgery patients with postoperative acute respiratory distress syndrome by prone-position pulmonary ventilation. Anesteziol Reanimatol. 2000;(5):42–5.
    1. Dirkes S, Dickinson S, Havey R, O'Brien D. Prone positioning: is it safe and effective? Crit Care Nurs Q. 2012;35(1):64–75. doi: 10.1097/CNQ.0b013e31823b20c6.
    1. ZhiJian H, RongChang C. Clinical application and nursing progress of prone position ventilation in acute respiratory distress syndrome. Int Respir J. 2006;26:452–453.
    1. Susan D, Sbaron D, Renee H. Prone positioning is it safe and effective? Crit Care Nurs Q. 2012;35(1):64–75. doi: 10.1097/CNQ.0b013e31823b20c6.

Source: PubMed

3
Se inscrever