Follow Us:Respiratio 2020, 2021, 2022; 10, 11, 12 (1-2-3): 197-203
ZNAČAJ PRON POZICIJE U TRETMANU AKUTNOG RESPIRATORNOG DISTRES SINDROMA POVEZANOG SA COVID19
PRONE POSITION IN THE TREATMENT OF ACUTE RESPIRATORY DISTRESS SYNDROME
CORELATED WITH COVID19
Dragana Marić1, Jovana Malić1, Biljana Zlojutro1, Danica Momčičević1,2, Saša Dragić1,2, Peđa Kovačević1,2
Review Article
Revijalni članak
Sažetak: Virus korona se pojavio u decembru 2019. godine u Wuhanu, Kina, odakle se veoma brzo
širio i marta 2020. godine poprimio pandemijske razmjere. Klinička slika može proći potpuno
asimptomatski ili da se manifestuje blagim simptomima od strane gornjih respiratornih puteva, ali može
dovesti i do upale donjih disajnih puteva različitog stepena težine. Teška forma bolesti može dovesti do
razvoja akutnog respiratornog distres sindroma (ARDS), odnosno do difuzne inflamatorne povrede pluća.
ARDS se manifestuje naglim početkom, teškom hipoksemijom i radiološki verifikovanim bilateralnim
plućnim infiltratima u odsustvu kardiogenog plućnog edema, a klasifikuje se prema stepenu hipoksemije
na blagi, umjereni i teški oblik. Tretman ARDS podrazumijeva primjenu sedativa i miorelaksanata,
intubaciju, mehaničku ventilaciju, pron položaj i rekrutment manevar. Kod bolesnika sa ARDS-om
okretanje iz ležećeg u potrbušni (pron) položaj dovodi do ravnomjernije preraspodjele gasova u tkivima i
poboljšanjem razmjene gasova u krvi. Poboljšanje oksigenacije i smanjenje smrtnosti su osnovne
indikacije za primjenu pron položaja kod bolesnika sa ARDS-om. Jedina apsolutna kontraindikacija za
postavljanje u pron položaj je nestabilan prelom kičmenog stuba. Sam manevar okretanja u pron/repron
položaj zahtijeva dobro utreniran tim medicinskih radnika. Najčešće komplikacije su dekubitusi i edemi
lica.
Ključne riječi: COVID19, ARDS, pron položaj
References
|
1. Tara NP, Becky AS. COVID-19: General approach to infection prevention in the health care setting. UpToDate, https://www.uptodate.com/contents/covid-19-general-approach-to-infection-prevention-in-thehealth-care-setting , pristupljeno 13.04.2022. godine |
|
|
|
|
|
2. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307:2526-2533. |
|
|
3. Katzenstein AL, Bloor CM, Leibow AA. Diffuse alveolardamage-the role of oxygen, shock, and relatedfactors: a review. Am J Pathol. 1976;85(1):209-228. |
|
|
4. ClaudeG, Richard KA, Jeremy B, Luciano G, Samir J, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med (2020) 46:2385-2396 |
|
|
5. Atul M. Prone ventilation for adult patients with acute respiratory distress syndrome. UpToDate, https://www.uptodate.com/contents/proneventilation-for-adult-patients-with-acute-respiratorydistress-syndrome pristupljeno 13.04.2022. godine |
|
|
6. George LA. COVID-19: Management of the intubated adult. UpToDate, https://www.uptodate.com/contents/covid-19-management-of-the-intubated-adult |
|
|
7. pristupljeno 13.04.2022. godine |
|
|
8. Mehdi CS, Paul D. W, Ian L. S, Deanna L. J, William AS, Vihren G. D, et al. Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome Due to COVID-19: A Cohort Study and Analysis of Physiology. Journal of Intensive Care Medicine. 2021, Vol. 36(2) 241-252 |
|
|
9. Ziehr DR, Alladina J, Petri CR, Maley JH, Moskowitz A, Medoff BD, Hibbert KA, Thompson BT, Hardin CC. Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study. J Respir Crit Care Med. 2020;201(12):1560. |
|
|
10. Pan C, Chen L, Lu C, Zhang W, Xia JA, Sklar MC, Du B, Brochard L, Qiu H. Lung Recruitability in COVID-19-associated Acute Respiratory Distressm Syndrome: A Single-Center Observational Study. J Respir Crit Care Med. 2020;201(10):1294. |
|
|
11. Weiss TT, Cerda F, Scott JB, Kaur R, Sungurlu S, Mirza SH, Alolaiwat AA, Kaur R, Augustynovich AE, Li J. Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study. Br J Anaesth. 2021;126(1):48. |
|
|
12. Mathew KS, Soh H, Shaefi S, Wang W, Bose S, Coca S, et al. Prone Positioning and |
|
|
13. Survival in Mechanically Ventilated Patients With Coronavirus Disease 2019-Related Respiratory Failure. Crit Care Med. 2021;49(7):1026. 14. Prone position in the treatment of acute respiratory distress syndrome corelated with COVID19. |
|
Dragana Marić
Ul. Dvanaest beba bb Banja Luka
Broj telefona: 065/807-321
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
1 Klinika intenzivne medicine za nehirurške grane, Univerzitetski klinički centar Republike Srpske,
Banja Luka, Bosna i Hercegovina
2 Medicinski fakultet, Univerzitet u Banjoj Luci, Banja Luka, Bosna i Hercegovina