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Translational studies in critical care
S77 Prone Positioning and Intravenous Steroids For the Management of Severe ARDS
  1. L Gupta,
  2. Ben SiuJames
  1. Regional Medical Center of San Jose, San Jose, USA

Abstract

Introduction Prone positioning and intravenous steroids represents a treatment option in patients with severe ARDS because most of the clinical manifestations in ARDS is secondary to excess fluid in the interstitium and alveoli and presence of inflammatory cells in the fluid.

Objective To assess the impact of prone positioning and steroids in severe ARDS and to assess and identify prognostic factors and potential predictors of mortality in ARDS patients.

Methods This is a retrospective study of 46 patients with severe ARDS from 2009–2011. The patient charts were reviewed and the impact of prone positioning and steroids was observed on severe ARDS patients. The primary outcome measured were ICU length of stay, number of ventilator days and 30 day mortality. Various prognostic factors such as history of diabetes, alcoholism, and presence of hypo-albuminemia, coagulopathy, sepsis and lactic acidosis were taken into account. Calculations were made in regards to the Lung Injury Predictive Score (LIPS) as determined by Chest Roentgenogram score, Hypoxemia Score, PEEP Score and Compliance score. The LIPS score was calculated for projecting the severity of ARDS. The use of statins on various outcome measures was also observed.

Results A total of 46 patients were treated in the ICU for ARDS. The number of ventilator days averaged from 5–35 days. The incidence of predisposing conditions as well as risk modifiers was correlated with the LIPS score. All of these patients were on ARDS net protocol and received intravenous antibiotics. Statistical analysis revealed a favourable impact of prone positioning with steroids on the mortality, duration of ICU stay and ventilator days. A significant difference in the LIPS score was noted in patients receiving IV steroids and prone positioning on day 2. Use of statins also influenced the duration of ICU stay and a significant impact on the mortality of this cohort of patients.

Conclusions Prone positioning is an effective adjunct intervention in conjunction with intravenous steroids for treating severe ARDS. It is a valid option for patients with refractory ARDS to conventional treatment. More studies need to be done to validate the impact of statins on different outcome measures in the ICU.

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