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Báo cáo y học: " Pro/con clinical debate: The use of prone positioning in the management of patients with acute respiratory distress syndrome"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Pro/con clinical debate: The use of prone positioning in the management of patients with acute respiratory distress syndrome. | Available online http ccforum.eom content 6 1 015 Commentary Pro con clinical debate The use of prone positioning in the management of patients with acute respiratory distress syndrome John J Marini and Gordon Rubenfeld Professor of Medicine University of Minnesota USA Assistant Professor Harborview Medical Center Washington USA Correspondence Critical Care Forum Editorial Office editorial@ccforum.com Published online 17 January 2002 Critical Care 2002 6 15-17 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Critical care medicine is a relatively new specialty and as such there is not a great deal of accumulated data to allow clinicians to practice evidence-based medicine in all situations they encounter. When evidence does exist intensivists may choose not to follow it based on gut feelings or their own interpretation of how the data apply to their patient. It is perhaps not surprising that these latter events occur given that intensivists are often literally fighting for their patient s lives. Prone positioning evokes a large emotional response from many intensivists. Despite accumulating data there appears to be two camps of clinicians those who strongly believe in the therapy and those who want more data. The emotion and rationale for the mindset of the two camps is evident in this issue of Critical Care Forum. With compelling arguments on both sides of the fence it is apparent that this debate is far from over. The authors of this pro con debate which is based on a clinical scenario first describe their position and then respond to their opponent s position. Keywords prone position ventilation ventilation-perfusion ratio The scenario A 29-year-old obese man is involved in a motor vehicle accident and has a pulmonary contusion that results in severe acute respiratory distress syndrome ARDS . He is mechanically ventilated with volume cycle ventilation tidal volume 6 ml kg ideal body weight a positive end-expiratory pressure of 18 cmH2O