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Early Clinical Efficacy of Prone Ventilation in Patients with Connective Tissue Disease-Related Interstitial Lung Disease with Concurrent Acute Respiratory Distress Syndrome

Received: 18 August 2022     Accepted: 4 September 2022     Published: 16 September 2022
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Abstract

In this prospective study, we aimed to compare the early (4h) clinical responses of prone conventional ventilation (CV) in connective tissue disease-related interstitial lung disease (CTD-ILD) patients with concurrent acute respiratory distress syndrome (ARDS). 40 patients with CTD-ILD combined with early onset of ARDS were recruited from May 2021 to March 2022 in the First Hospital of Jinmen, China. They were separated into two groups (n=20 per group). Patients in the control group were given routine treatment, which included infection control, correcting electrolyte disorder, correcting the acid-base imbalance, and nutritional support, etc. For the intervention group, additional conventional ventilation in the prone position (prone-CV) was provided. The following indicators were monitored, including respiratory rate (RR), heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP). The changes in sequential organ failure assessment score (SOFA), respiratory dynamic indexes (RR and PaO2/FIO2) and hemodynamics, including HR, CVP (mm Hg) and MAP (mmHg) were compared before and 4 hours after treatment. After 4 h of treatment, patients in the prone-CV group had significantly lowered SOFA scores (9.134 ± 1.12 vs. 10.03 ± 0.84, p = 0.007) and improved PaO2/FIO2 ratio (184.8 ± 35.59 vs. 104.2 ± 14.64, p < 0.001) compared to the control group. The hemodynamics, including HR, MAP and CVP were stable. In conclusion, early administration of Prone-CV could rapidly improve the SOFA score and oxygenation among CTD-ILD patients during acute exacerbations of ARDS.

Published in Clinical Medicine Research (Volume 11, Issue 5)
DOI 10.11648/j.cmr.20221105.13
Page(s) 130-134
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

CTD, ILD, Prone-CV, Oxygenation

References
[1] Yoo H, Hino T, Han J, et al. Connective tissue disease-related interstitial lung disease (CTD-ILD) and interstitial lung abnormality (ILA): Evolving concept of CT findings, pathology and management [J]. Eur J Radiol Open, 2021, 8: 100311.
[2] Wells AU. New insights into the treatment of CTD-ILD [J]. Nat Rev Rheumatol, 2021, 17 (2): 79-80.
[3] Jeganathan N and Sathananthan M. Connective Tissue Disease-Related Interstitial Lung Disease: Prevalence, Patterns, Predictors, Prognosis, and Treatment [J]. Lung, 2020, 198 (5): 735-759.
[4] Ahmed S and Handa R. Management of Connective Tissue Disease-related Interstitial Lung Disease [J]. Curr Pulmonol Rep, 2022: 1-13.
[5] Yoo H, Hino T, Hwang J, et al. Connective tissue disease-related interstitial lung disease (CTD-ILD) and interstitial lung abnormality (ILA): Evolving concept of CT findings, pathology and management [J]. Eur J Radiol Open, 2022, 9: 100419.
[6] Shi Y, Zhang Y, Liu R, et al. The "Hand as Foot" teaching method in the ultrasound characteristics of connective tissue diseases associated interstitial lung disease (CTD-ILD) [J]. Asian J Surg, 2022.
[7] Putman RK, Hunninghake GM, Dieffenbach PB, et al. Interstitial Lung Abnormalities Are Associated with Acute Respiratory Distress Syndrome [J]. Am J Respir Crit Care Med, 2017, 195 (1): 138-141.
[8] Erre GL, Sebastiani M, Manfredi A, et al. Antifibrotic drugs in connective tissue disease-related interstitial lung disease (CTD-ILD): from mechanistic insights to therapeutic applications [J]. Drugs Context, 2021, 10.
[9] Fan E, Brodie D and Slutsky AS. Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment [J]. JAMA, 2018, 319 (7): 698-710.
[10] Kallet RH. A Comprehensive Review of Prone Position in ARDS [J]. Respir Care, 2015, 60 (11): 1660-1687.
[11] Roche-Campo F, Aguirre-Bermeo H and Mancebo J. Prone positioning in acute respiratory distress syndrome (ARDS): when and how? [J]. Presse Med, 2011, 40 (12 Pt 2): e585-594.
[12] Guerin C, Albert RK, Beitler J, et al. Prone position in ARDS patients: why, when, how and for whom [J]. Intensive Care Med, 2020, 46 (12): 2385-2396.
[13] Xu Y, Sun Q, Yu Y, et al. Prone position ventilation support for acute exacerbation of interstitial lung disease? [J]. Clin Respir J, 2018, 12 (4): 1372-1380.
[14] Nakos G, Tsangaris I, Kostanti E, et al. Effect of the prone position on patients with hydrostatic pulmonary edema compared with patients with acute respiratory distress syndrome and pulmonary fibrosis [J]. Am J Respir Crit Care Med, 2000, 161 (2 Pt 1): 360-368.
[15] Vacchi C, Sebastiani M, Cassone G, et al. Therapeutic Options for the Treatment of Interstitial Lung Disease Related to Connective Tissue Diseases. A Narrative Review [J]. J Clin Med, 2020, 9 (2).
[16] Adler S, Huscher D, Siegert E, et al. Systemic sclerosis associated interstitial lung disease - individualized immunosuppressive therapy and course of lung function: results of the EUSTAR group [J]. Arthritis Res Ther, 2018, 20 (1): 17.
[17] Jiwrajka N, Loizidis G, Patterson KC, et al. Identification and Prognosis of Patients With Interstitial Pneumonia With Autoimmune Features [J]. J Clin Rheumatol, 2022.
[18] Sklar MC, Fan E and Goligher EC. High-Frequency Oscillatory Ventilation in Adults With ARDS: Past, Present, and Future [J]. Chest, 2017, 152 (6): 1306-1317.
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  • APA Style

    Ying Zhou, Ming Jin, Guohui Yu. (2022). Early Clinical Efficacy of Prone Ventilation in Patients with Connective Tissue Disease-Related Interstitial Lung Disease with Concurrent Acute Respiratory Distress Syndrome. Clinical Medicine Research, 11(5), 130-134. https://doi.org/10.11648/j.cmr.20221105.13

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    ACS Style

    Ying Zhou; Ming Jin; Guohui Yu. Early Clinical Efficacy of Prone Ventilation in Patients with Connective Tissue Disease-Related Interstitial Lung Disease with Concurrent Acute Respiratory Distress Syndrome. Clin. Med. Res. 2022, 11(5), 130-134. doi: 10.11648/j.cmr.20221105.13

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    AMA Style

    Ying Zhou, Ming Jin, Guohui Yu. Early Clinical Efficacy of Prone Ventilation in Patients with Connective Tissue Disease-Related Interstitial Lung Disease with Concurrent Acute Respiratory Distress Syndrome. Clin Med Res. 2022;11(5):130-134. doi: 10.11648/j.cmr.20221105.13

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  • @article{10.11648/j.cmr.20221105.13,
      author = {Ying Zhou and Ming Jin and Guohui Yu},
      title = {Early Clinical Efficacy of Prone Ventilation in Patients with Connective Tissue Disease-Related Interstitial Lung Disease with Concurrent Acute Respiratory Distress Syndrome},
      journal = {Clinical Medicine Research},
      volume = {11},
      number = {5},
      pages = {130-134},
      doi = {10.11648/j.cmr.20221105.13},
      url = {https://doi.org/10.11648/j.cmr.20221105.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20221105.13},
      abstract = {In this prospective study, we aimed to compare the early (4h) clinical responses of prone conventional ventilation (CV) in connective tissue disease-related interstitial lung disease (CTD-ILD) patients with concurrent acute respiratory distress syndrome (ARDS). 40 patients with CTD-ILD combined with early onset of ARDS were recruited from May 2021 to March 2022 in the First Hospital of Jinmen, China. They were separated into two groups (n=20 per group). Patients in the control group were given routine treatment, which included infection control, correcting electrolyte disorder, correcting the acid-base imbalance, and nutritional support, etc. For the intervention group, additional conventional ventilation in the prone position (prone-CV) was provided. The following indicators were monitored, including respiratory rate (RR), heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP). The changes in sequential organ failure assessment score (SOFA), respiratory dynamic indexes (RR and PaO2/FIO2) and hemodynamics, including HR, CVP (mm Hg) and MAP (mmHg) were compared before and 4 hours after treatment. After 4 h of treatment, patients in the prone-CV group had significantly lowered SOFA scores (9.134 ± 1.12 vs. 10.03 ± 0.84, p = 0.007) and improved PaO2/FIO2 ratio (184.8 ± 35.59 vs. 104.2 ± 14.64, p < 0.001) compared to the control group. The hemodynamics, including HR, MAP and CVP were stable. In conclusion, early administration of Prone-CV could rapidly improve the SOFA score and oxygenation among CTD-ILD patients during acute exacerbations of ARDS.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Early Clinical Efficacy of Prone Ventilation in Patients with Connective Tissue Disease-Related Interstitial Lung Disease with Concurrent Acute Respiratory Distress Syndrome
    AU  - Ying Zhou
    AU  - Ming Jin
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    AB  - In this prospective study, we aimed to compare the early (4h) clinical responses of prone conventional ventilation (CV) in connective tissue disease-related interstitial lung disease (CTD-ILD) patients with concurrent acute respiratory distress syndrome (ARDS). 40 patients with CTD-ILD combined with early onset of ARDS were recruited from May 2021 to March 2022 in the First Hospital of Jinmen, China. They were separated into two groups (n=20 per group). Patients in the control group were given routine treatment, which included infection control, correcting electrolyte disorder, correcting the acid-base imbalance, and nutritional support, etc. For the intervention group, additional conventional ventilation in the prone position (prone-CV) was provided. The following indicators were monitored, including respiratory rate (RR), heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP). The changes in sequential organ failure assessment score (SOFA), respiratory dynamic indexes (RR and PaO2/FIO2) and hemodynamics, including HR, CVP (mm Hg) and MAP (mmHg) were compared before and 4 hours after treatment. After 4 h of treatment, patients in the prone-CV group had significantly lowered SOFA scores (9.134 ± 1.12 vs. 10.03 ± 0.84, p = 0.007) and improved PaO2/FIO2 ratio (184.8 ± 35.59 vs. 104.2 ± 14.64, p < 0.001) compared to the control group. The hemodynamics, including HR, MAP and CVP were stable. In conclusion, early administration of Prone-CV could rapidly improve the SOFA score and oxygenation among CTD-ILD patients during acute exacerbations of ARDS.
    VL  - 11
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    ER  - 

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Author Information
  • Pulmonary and Critical Care Medicine, Jingmen No. 1 People’s Hospital, Jingmen, China

  • Pulmonary and Critical Care Medicine, Jingmen No. 1 People’s Hospital, Jingmen, China

  • Pulmonary and Critical Care Medicine, Jingmen No. 1 People’s Hospital, Jingmen, China

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