RESUMO
SUMMARY OBJECTIVE: This study aimed to assess the effect of prone position on oxygenation and lung recruitability in patients with acute respiratory distress syndrome due to COVID-19 receiving invasive mechanical ventilation. METHODS: This prospective study was conducted in the intensive care unit between December 10, 2021, and February 10, 2022. We included 25 patients admitted to our intensive care unit with acute respiratory distress syndrome due to COVID-19 who had undergone prone position. We measured the respiratory system compliance, recruitment to inflation ratio, and PaO2/FiO2 ratio during the baseline supine, prone, and resupine positions. The recruitment to inflation ratio was used to assess the potential for lung recruitability. RESULTS: In the prone position, PaO2/FiO2 increased from 82.7 to 164.4 mmHg (p<0.001) with an increase in respiratory system compliance (p=0.003). PaO2/FiO2 decreased to 117 mmHg (p=0.015) in the resupine with no change in respiratory system compliance (p=0.097). The recruitment to inflation ratio did not change in the prone and resupine positions (p=0.198 and p=0.621, respectively). In all patients, the median value of respiratory system compliance during supine was 26 mL/cmH2O. In patients with respiratory system compliance<26 mL/cmH2O (n=12), respiratory system compliance increased and recruitment to inflation decreased from supine to prone positions (p=0.008 and p=0.040, respectively), whereas they did not change in those with respiratory system compliance ≥26 mL/cmH2O8 (n=13) (p=0.279 and p=0.550, respectively) (ClinicalTrials registration number: NCT05150847). CONCLUSION: In the prone position, in addition to the oxygenation benefit in all patients, we detected lung recruitment based on the change in the recruitment to inflation ratio with an increase in respiratory system compliance only in acute respiratory distress syndrome due to COVID-19 patients who have <26 mL/cmH2O baseline supine respiratory compliance.
RESUMO
Resumo Fundamento: A síndrome hemofagocítica (SHF) é uma síndrome hiperinflamatória debilitante. O status da insuficiência cardíaca (IC) com fração de ejeção preservada (ICFEP) está intimamente relacionado ao aumento da inflamação sistêmica e intramiocárdica. Objetivos: este estudo pretende determinar os preditores de mortalidade e os parâmetros de monitoramento confiáveis nos casos de SHF que desenvolveram a ICFEP durante seu curso clínico. Métodos: Trinta e nove pacientes, diagnosticados com SHF de acordo com os critérios diagnósticos do estudo HLH 2004 com Hscore ≥169, e com aspiração ou biópsia de medula óssea comprovada, foram recrutados retrospectivamente. Foram investigados retrospectivamente os fatores de risco tradicionais, como proteína C reativa sérica, níveis de albumina e ferritina com contagens de linfócitos e plaquetas, e fatores não tradicionais, como relação neutrófilolinfócito (NLR), relação linfócito-monócito (MLR), volume plaquetário médio (MPV) e pró-peptídeo natriurético cerebral N-terminal (NTproBNP). Analisou-se a relação entre os valores laboratoriais alterados ao longo do tempo entre si e com a mortalidade. O nível de significância geral foi de 5%. Resultados: Foi demonstrado que a alteração temporal dos níveis de índice cardiotorácico (ICT), NTproBNP sérico, ferritina, PCR e albumina foram detectados como sendo preditores de mortalidade (p<0,05, para todos) em análise univariada. As contagens de linfócitos e plaquetas com valores de NLR e MPV também foram significativos (p<0,05). A relação entre NT-proBNP e o aumento dos marcadores inflamatórios sistêmicos também foi considerada significativa. Além de fatores de risco tradicionais, os níveis de ferritina sérica, e os níveis de NLR, MLR e MPV foram considerados significativamente correlacionados entre si. Conclusão: Acompanhado de parâmetros de monitoramento confiáveis, o diagnóstico rápido e o tratamento antiinflamatório agressivo com controle rígido de volume podem salvar vidas de pacientes com SHF que sofrem de complicações por ICFEP. O monitoramento rígido da inflamação pode prever o resultado do paciente que sofre de ICFEP.
Abstract Background: Hemophagocytic syndrome (HPS) ia s devastating hyperinflammatory syndrome. Heart failure (HF) with preserved ejection fraction (HFpEF) status is closely correlated with increased inflammation, both systemic and intramyocardial. Objectives: This study sought to determine mortality predictors and reliable follow-up parameters in HPS that developed HFpEF during the clinical course. Method: Thirty-nine patients, diagnosed as HPS, according to HLH 2004 diagnostic criteria, with an HScore of ≥169 and proven bone marrow aspiration or biopsy, were recruited retrospectively. Both traditional, serum C-reactive protein, albumin and ferritin levels with lymphocyte, and platelet counts, as well as non-traditional risk factors, neutrophil-to-lymphocyte count (NLR), monocyte-to-lymphocyte count (MLR), mean platelet volume (MPV), and N-Terminal pro-brain natriuretic peptide (NTproBNP), were investigated retrospectively. The relationship between time-changed laboratory values both among themselves and with mortality. The overall significance level was set at 5%. Results: This study showed that temporal change of cardiothoracic ratio (CTR), serum NTproBNP, ferritin, CRP, and albumin levels were detected as mortality predictors (p<0.05, for all) in the univariate analysis. Lymphocyte and platelet counts with NLR and MPV values were also significant (p<0.05). The relationship between NT-proBNP and increased systemic inflammatory markers proved to be significant. In addition to traditional risk factors, serum ferritin levels, NLR, MLR, and MPV levels also proved to be significantly correlated with each other. Conclusion: Accompanied by reliable follow-up parameters, rapid diagnosis and aggressive anti-inflammatory treatment with tight volume control can be life-saving in HPS patients who suffer from HFpEF. Close monitoring of inflammation may predict the outcome of patients suffering from HFpEF.