Posición prona y oxigenación por membrana extracorpórea en el síndrome de dificultad respiratoria del adulto

Dalmedico, Michel; Ramos, Débora; Hinata, Paula; Alves, Waleska; Carvalho, Chayane; Avila, Juliana

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ORIGINAL ARTICLE • Fisioter. mov. 32 • 2019 • https://doi.org/10.1590/1980-5918.032.AO35 copiar

Posición prona y oxigenación por membrana extracorpórea en el síndrome de dificultad respiratoria del adulto

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

Introducción:

El síndrome de dificultad respiratoria aguda es un proceso inflamatorio derivado de una variedad de enfermedades graves, que resulta en el edema proteico no hidrostático del parénquima pulmonar. Siendo que determina hipoxemia refractaria, displasia alveolar difusa, reducción de la complacencia e hipercarbia la pérdida de la capacidad del pulmón para eliminar dióxido de carbono. El tratamiento del síndrome de dificultad respiratoria aguda consiste principalmente en medidas para evitar la progresión de la lesión pulmonar y optimizar la oxigenación.

Objetivo:

identificar en la literatura científica internacional los casos o series de casos que revelan la aplicación combinada de la posición prona y la oxigenación con membrana extracorpórea en pacientes con síndrome de dificultad respiratoria aguda, así como el beneficio de estas terapias de rescate.

Método:

revisión sistemática de informes de casos que reflejan el beneficio de terapias combinadas en el tratamiento de pacientes con este síndrome.

Resultados:

desde la estrategia de búsqueda y los criterios de selección, se incluyeron 8 estudios que informaron 19 casos de pacientes con este síndrome que recibieron una combinación de estos tratamientos de rescate. Todos los estudios evidenciaron que la oxigenación con membrana extracorpórea fue la intervención primaria. No hubo informes de eventos adversos.

Conclusión:

las combinaciones de terapias interfieren positivamente en el pronóstico de los pacientes con este síndrome, además de que no presentan riesgos adicionales a la ocurrencia de eventos adversos, sin embargo, la posición prona debe preceder a la oxigenación con membrana extracorpórea, mientras la intervención de primera elección. Registro PROSPERO CRD42018093076

Palabras clave:
Síndrome de Dificultad Respiratoria del Adulto; Oxigenación por Membrana Extracorpórea; Posición Prona; Informes de Casos; Práctica Clínica Basada en la Evidencia

Authors/Year	Title	Journal/Database
He et al. (2017)¹⁷17 He H, Wang H, Li X, Tang X, Wang R, Sun B, et al. Successful rescue combination of extracorporeal membrane oxygenation, high-frequency oscillatory ventilation and prone positioning for the management of severe methicillin-resistant Staphylococcus aureus pneumonia complicated by pneumothorax: a case report and literature review. BMC Pulm Med. 2017;17(1):103.	Successful rescue combination of extracorporeal membrane oxygenation, high-frequency oscillatory ventilation and prone positioning for the management of severe methicillin-resistant Staphylococcus aureus pneumonia complicated by pneumothorax: a case report and literature review	PubMed/ BMC Pulm Med
Azimzadeh et al. (2017)¹⁸18 Azimzadeh N, Baram M, Cavarocchi N, Hirose H. Prone position: does it help with acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO)? OJRD. 2017;7(1):18-24.	Prone position: Does it help with acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO)?	Gray Literature/ OJRD
Brunauer et al. (2015)¹⁹19 Brunauer A, Dankl D, Dünser MW. Incomplete (135°) prone position as an alternative to full prone position for lung recruitment in ARDS during ECMO therapy. Wien Klin Wochenschr. 2015;127(3-4):149-50.	Incomplete (135°) prone position as an alternative to full prone position for lung recruitment in ARDS during ECMO therapy	PubMed/ Winklin Wichenschr
Masuda et al. (2014)²⁰20 Masuda Y, Tatsumi H, Imaizumi H, Gotoh K, Yoshida S, Chihara S, et al. Effect of prone positioning on cannula function and impaired oxygenation during extracorporeal circulation. J Artif Organs. 2014;17(1):106-9.	Effect of prone positioning on cannula function and impaired oxygenation during extracorporeal circulation	PubMed/J Artific Organs
Kredel et al. (2014)²¹21 Kredel M, Bischof L, Wurmb TE, Roewer N, Muellenbach RM. Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients. Perfusion. 2014;29(2):171-7.	Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients	PubMed/Perfusion
Kipping et al. (2013)²²22 2. Kipping V, Weber-Carstens S, Lojewski C, Feldmann P, Rydlewski A, Boemke W, et al. Prone position during ECMO is safe and improves oxygenation. Int J Artif Organs. 2013;36(11):821-32.	Prone position during ECMO is safe and improves oxygenation	PubMed/ Int J Artif Organs
Litmathe et al. (2012)²³23 3. Litmathe J, Sucker C, Easo J, Wigger L, Dapunt O. Prone and ECMO: a contradiction per se? Perfusion. 2012;27(1):78-82.	Prone and ECMO - a contradiction per se?	PubMed/ Perfusion
Otterspoor et al. (2012)²⁴24 4. Otterspoor LC, Smit FH, van Laar TJ, Kesecioglu J, van Dijk D. Prolonged use of extracorporeal membrane oxygenation combined with prone positioning in patients with acute respiratory distress syndrome and invasive Aspergillosis. Perfusion. 2012;27(4):335-7.	Prolonged use of extracorporeal membrane oxygenation combined with prone positioning in patients with acute respiratory distress syndrome and invasive Aspergillosis	Pubmed/Perfusion

Articles	Length of stay in ECMO	Length of stay in ECMO and prone (days)	Length of stay in ECMO and prone (hours/day; total hours)	Prone Angulation	Adverse events
He et al. (2017) ¹⁷17 He H, Wang H, Li X, Tang X, Wang R, Sun B, et al. Successful rescue combination of extracorporeal membrane oxygenation, high-frequency oscillatory ventilation and prone positioning for the management of severe methicillin-resistant Staphylococcus aureus pneumonia complicated by pneumothorax: a case report and literature review. BMC Pulm Med. 2017;17(1):103.	19 days	12 days	8 hours/day	180°	No adverse events
Azimzadeh et al. (2017) ¹⁸18 Azimzadeh N, Baram M, Cavarocchi N, Hirose H. Prone position: does it help with acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO)? OJRD. 2017;7(1):18-24.	25 days	8 days	16 hours/day	180°	No adverse events
Brunauer et al. (2015) ¹⁹19 Brunauer A, Dankl D, Dünser MW. Incomplete (135°) prone position as an alternative to full prone position for lung recruitment in ARDS during ECMO therapy. Wien Klin Wochenschr. 2015;127(3-4):149-50.	2 days	2 days	16 hours/day	135°	No adverse events
Masuda et al. (2014) ²⁰20 Masuda Y, Tatsumi H, Imaizumi H, Gotoh K, Yoshida S, Chihara S, et al. Effect of prone positioning on cannula function and impaired oxygenation during extracorporeal circulation. J Artif Organs. 2014;17(1):106-9.	Unreported	1 day	15 hours/day	180°	Unreported
Masuda et al. (2014) ²⁰20 Masuda Y, Tatsumi H, Imaizumi H, Gotoh K, Yoshida S, Chihara S, et al. Effect of prone positioning on cannula function and impaired oxygenation during extracorporeal circulation. J Artif Organs. 2014;17(1):106-9. Case 2	Unreported	2 days	15.5 hours/day	180°	Unreported
Kredel et al. (2014) ²¹21 Kredel M, Bischof L, Wurmb TE, Roewer N, Muellenbach RM. Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients. Perfusion. 2014;29(2):171-7.	Unreported	12h average of each patient	97h in total	135°	No adverse events
Kredel et al. (2014) ²¹21 Kredel M, Bischof L, Wurmb TE, Roewer N, Muellenbach RM. Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients. Perfusion. 2014;29(2):171-7. Case 2	Unreported	Unreported	249h in total	135°	No adverse events
Kredel et al. (2014) ²¹21 Kredel M, Bischof L, Wurmb TE, Roewer N, Muellenbach RM. Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients. Perfusion. 2014;29(2):171-7. Case 3	Unreported	Unreported	125h in total	135°	No adverse events
Kredel et al. (2014) ²¹21 Kredel M, Bischof L, Wurmb TE, Roewer N, Muellenbach RM. Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients. Perfusion. 2014;29(2):171-7. Case 4	Unreported	Unreported	352h in total	180°	No adverse events
Kipping et al. (2013) ²²22 2. Kipping V, Weber-Carstens S, Lojewski C, Feldmann P, Rydlewski A, Boemke W, et al. Prone position during ECMO is safe and improves oxygenation. Int J Artif Organs. 2013;36(11):821-32.	8 days	6 days	Unreported	180°	Unreported
Kipping et al. (2013) ²²22 2. Kipping V, Weber-Carstens S, Lojewski C, Feldmann P, Rydlewski A, Boemke W, et al. Prone position during ECMO is safe and improves oxygenation. Int J Artif Organs. 2013;36(11):821-32. Case 2	10 days	6 days	Unreported	180°	Unreported
Kipping et al. (2013) ²²22 2. Kipping V, Weber-Carstens S, Lojewski C, Feldmann P, Rydlewski A, Boemke W, et al. Prone position during ECMO is safe and improves oxygenation. Int J Artif Organs. 2013;36(11):821-32. Case 3	16 days	13 days	Unreported	180°	Unreported
Kipping et al. (2013) ²²22 2. Kipping V, Weber-Carstens S, Lojewski C, Feldmann P, Rydlewski A, Boemke W, et al. Prone position during ECMO is safe and improves oxygenation. Int J Artif Organs. 2013;36(11):821-32. Case 4	14 days	6 days	Unreported	180°	Unreported
Kipping et al. (2013) ²²22 2. Kipping V, Weber-Carstens S, Lojewski C, Feldmann P, Rydlewski A, Boemke W, et al. Prone position during ECMO is safe and improves oxygenation. Int J Artif Organs. 2013;36(11):821-32. Case 5	5 days	5 days	Unreported	180°	Unreported
Kipping et al. (2013) ²²22 2. Kipping V, Weber-Carstens S, Lojewski C, Feldmann P, Rydlewski A, Boemke W, et al. Prone position during ECMO is safe and improves oxygenation. Int J Artif Organs. 2013;36(11):821-32. Case 6	6 days	4 days	Unreported	180°	Unreported
Litmathe et al. (2012) ²³23 3. Litmathe J, Sucker C, Easo J, Wigger L, Dapunt O. Prone and ECMO: a contradiction per se? Perfusion. 2012;27(1):78-82.	9 days	3 days	4 hours/day	135°	No adverse events
Litmathe et al. (2012) ²³23 3. Litmathe J, Sucker C, Easo J, Wigger L, Dapunt O. Prone and ECMO: a contradiction per se? Perfusion. 2012;27(1):78-82. Case 2	4 days	4 days	4 hours/day	135°	No adverse events
Otterspoor et al. (2012) ²⁴24 4. Otterspoor LC, Smit FH, van Laar TJ, Kesecioglu J, van Dijk D. Prolonged use of extracorporeal membrane oxygenation combined with prone positioning in patients with acute respiratory distress syndrome and invasive Aspergillosis. Perfusion. 2012;27(4):335-7.	45 days	3 days	Unreported	180°	No adverse events
Otterspoor et al. (2012) ²⁴24 4. Otterspoor LC, Smit FH, van Laar TJ, Kesecioglu J, van Dijk D. Prolonged use of extracorporeal membrane oxygenation combined with prone positioning in patients with acute respiratory distress syndrome and invasive Aspergillosis. Perfusion. 2012;27(4):335-7. Case 2	52 days	6 days	Unreported	180°	No adverse events

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[1] *MD: Doctoral student, e-mail: micheldalmedico@yahoo.com.br