الفهرس 
Acute Respiratory Distress SyndromeOnly 14 pages are availabe for public view
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Abstract
T
he inflammation causes fluid from nearby blood vessels to leak into the tiny air sacs in lungs, making breathing increasingly difficult. ARDS is characterized by acute onset of tachypnea, hypoxemia, and loss of lung compliance. Significant atelectasis is also frequently present. It is associated with increased length of stay in the intensive care unit (ICU), long hospital stays, higher hospital charges as well as increased morbidity and mortality.
High Flow Nasal Oxygen (HFNO2) therapy provides warmed humidified oxygen and low-level, flow-dependent positive airways pressure, and may be more tolerable than Continuous positive airway pressure (CPAP) or non-invasive ventilation; also, HFNO2 improves washout of nasopharyngeal dead space, resulting in improved oxygenation. High-flow nasal cannula (HFNC) therapy is an oxygen supply system capable of delivering up to 100% humidified and heated oxygen at a flow rate of up to 60 liters per minute. In giving prophylactic support to mild ARDS patients from intubation.
Proning is the act or practice of placing a patient and especially one in respiratory distress in the prone position with the chest and stomach facing downward to increase blood oxygenation. Proning places the lung in its ’natural’ posture, and thus optimizes the ventilation-perfusion distribution, which enables lung protective ventilation and the alleviation of potentially life-threatening hypoxemia in critical illness with respiratory failure. ARDS happens when the lungs become severely inflamed from an infection or injury.
In this study aim of work is to evaluate the effect of self-Proning with high flow nasal canula in patients with ARDS on oxygenation and incidence of intubation.
90 patients were divided into two equal groups and subjected to a prospective, randomized, double-blind clinical trial; group I patients received HFNC whereas group II patients received HFNC and Proning. Patients were advised to remain prone for as long as comfortable.
All patients with BMIs under 30 kg/m2, all patients were COVID positive with mild ARDS according to the Berlin criteria. Within the first 24 hours of admission to the surgical ICU, patients with mild ARDS were treated with NIV (CPAP/BIPAP mode). FIO2 for 30 minutes at 0.5 PEEP at 5 cm H2O.
that, a patient with (PaO2/FiO2 ratio of 200–300) was enrolled in the trial and alternately split into two groups using simple randomization. initially self-Proning was encouraged If the patient tolerates being prone well, HFNC was applied for at least 30 minutes. The prone position was kept. The prone position was held for 8 hours each day. Any patient whose SPO2 fell below 90% in any group was treated in accordance with Ain Shams University’s ICU guidelines. If the patient’s condition did not improve with noninvasive ventilation, the patient was either given intubation and mechanical ventilation. The prone posture was used without sedation.
The Combination of Proning and high flow nasal cannula improved hemodynamics of mild ARDS patients in heart rate and respiratory rate have become lower in group 2 than in group 1.spo2 and p/f ratio have become higher in group 2 than in group 1.
Proning and high flow nasal cannula were successful in reducing the incidence of intubation (11 patients in group 1, 4 in group 2), mortality (35 survived in group 1, 42 survived in group 2), and length of stay in the intensive care unit (ICU) for the patients with mild ARDS.
Our study has shown that combination of high flow nasal oxygen therapy and Proning was effective in improving oxygenation of the mild ARDS patients and decreasing incidence of intubation, mortality and ICU stay in these patients.