Prone position in acute respiratory distress syndrome after open-heart surgery

Martín S. Markov, Servicio de Kinesiología y Rehabilitación, Hospital El Cruce, Florencio Varela, Buenos Aires, Argentina

Acute respiratory distress syndrome (ARDS) is one of the main causes of postoperative respiratory failure, associated with a high mortality rate in patients undergoing cardiac surgery. Although there is robust evidence regarding the benefits of the prone position maneuver in terms of oxygenation, ventilatory mechanics, and mortality, it is not free of complications, and therefore of relative and absolute contraindications. A review of the literature was carried out regarding the safety and efficacy of the prone position maneuver in patients after recent cardiac surgery with median sternotomy who develop ARDS under invasive mechanical ventilation. It is concluded that, in an appropriate setting, with experienced personnel and necessary care, the prone position could be safe in this type of patients. Studies of higher methodological quality and with better discrimination of the reason for refractory hypoxemia are needed to determine the efficacy in patients who develop ARDS after cardiac surgery with median sternotomy in terms of in-hospital mortality.

Keywords: Prone position. Cardiac surgery. Respiratory distress syndrome.