Subject(s)
Fever/etiology , Fever/therapy , Heart Transplantation , Adult , Anti-Bacterial Agents/therapeutic use , Cardiomyopathy, Dilated/surgery , Diagnosis, Differential , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/microbiology , Fever/diagnostic imaging , Heart-Assist Devices , Humans , Male , Patient Readmission , Postoperative Complications/drug therapy , Postoperative Complications/etiology , Thorax/diagnostic imagingABSTRACT
INTRODUCTION: Prone position ventilation has been shown to improve oxygenation and ventilatory mechanics in patients with acute respiratory distress syndrome. We evaluated whether prone ventilation reduces the risk of mortality in adult patients with acute respiratory distress syndrome versus supine ventilation. METHODOLOGY: A metaanalysis of randomized controlled trials comparing patients in supine versus prone position was performed. A search was conducted of the Pubmed, Embase, Cochrane Library, and LILACS databases. Mortality, hospital length of stay, days of mechanical ventilation and adverse effects were evaluated. RESULTS: Seven randomized controlled trials (2,119 patients) were included in the analysis. The prone position showed a nonsignificant tendency to reduce mortality (OR: 0.76; 95%CI: 0.54 to 1.06; P=.11, I(2) 63%). When stratified by subgroups, a significant decrease was seen in the risk of mortality in patients ventilated with low tidal volume (OR: 0.58; 95%CI: 0.38 to 0.87; P=.009, I(2) 33%), prolonged pronation (OR: 0.6; 95%CI: 0.43 to 0.83; p=.002, I(2) 27%), start within the first 48hours of disease evolution (OR 0.49; 95%CI 0.35 to 0.68; P=.0001, I(2) 0%) and severe hypoxemia (OR: 0.51: 95%CI: 0.36 to 1.25; P=.0001, I(2) 0%). Adverse effects associated with pronation were the development of pressure ulcers and endotracheal tube obstruction. CONCLUSIONS: Prone position ventilation is a safe strategy and reduces mortality in patients with severely impaired oxygenation. It should be started early, for prolonged periods, and should be associated to a protective ventilation strategy.
Subject(s)
Patient Positioning , Prone Position , Respiration, Artificial/methods , Respiratory Distress Syndrome/therapy , Adolescent , Adult , Aged , Airway Obstruction/etiology , Hospital Mortality , Humans , Hypoxia/etiology , Hypoxia/prevention & control , Intubation, Intratracheal , Length of Stay/statistics & numerical data , Middle Aged , Patient Positioning/adverse effects , Pressure Ulcer/etiology , Randomized Controlled Trials as Topic , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome/complications , Respiratory Distress Syndrome/mortality , Respiratory Distress Syndrome/physiopathology , Respiratory Mechanics/physiology , Ventilator-Induced Lung Injury/etiology , Ventilator-Induced Lung Injury/prevention & control , Young AdultABSTRACT
Las infecciones necrotizantes de los tejidos blandos, a pesar de ser una patologia infrecuente, tienen una elevada mortalidad en nuestro medio. La sospecha clinica y el tratamiento quirurgico temprano constituyen la piedra angular en su terapeutica. Se presenta una revision bibliográfica y la experiencia institucional en un Hospital de tercer nivel, durante los ultimas 5 años.