ObjectiveTo investigate the effects of prone position ventilation on oxygenation,hemodynamics and airway drainage in patients with severe aspiration pneumonia with acute respiratory distress syndrome (ARDS). Methods28 patients with severe aspiration pneumonia with ARDS admitted between January 2010 and June 2012 were recruited in the study. They were ventilated in prone position with sedation and paralysis. Mean blood pressure (MAP),heart rate (HR),central venous pressure (CVP),pulse oxygen saturation (SpO2),arterial oxygen tension (PaO2),carbon dioxide partial pressure (PaCO2),oxygenation index (PaO2/FiO2) and sputum drainage were recorded in the time points of initial supine position,prone position 1h,prone position 2h,and return to supine position 2h. ResultsCompared with the time point of initial supine position,PaO2 and PaO2/FiO2 increased significantly after 1 and 2 hours in prone position [PaO2:(85±12)mm Hg and (97±10)mm Hg vs. (65±11)mm Hg;PaO2/FiO2:(150±37)mm Hg and (158±50)mm Hg vs. (130±28)mm Hg;all P<0.05]. The effects of oxygenation improving were persistent 2h after return to supine position [PaO2:(87±11)mm Hg;PaO2/FiO2:(150±52)mm Hg,P<0.05]. There was no significant difference in MAP,HR,CVP,or SpO2 during the study. Airway sputum drainage was significantly increased 2h after in prone position compared with that in initial supine position [(15.3±2.0)mL vs. (8.1±1.1)mL,P<0.05]. Airway sputum drainage had no significant difference among 1h afer prone position,2h after return to supine position and the initial supine position [(9.1±1.0)mL and (8.3±1.2) mL vs. (8.1±1.1)mL,P>0.05]. ConclusionProne position ventilation can improve the oxygenation in patients with severe aspiration pneumonia with ARDS,and the effects of oxygenation improvement can be persistent till 2h after return to supine position. Prone position ventilation can improve sputum drainage without significant influence on hemodynamics,thus can be used as an adjuvant treatment for severe aspiration pneumonia with ARDS. The duration of prone position ventilation needs to be prolonged for patients with much airway secretion.
Objective To explore independent risk factors for aspiration pneumonia (AP) in ICU patients receiving mechanical ventilation (MV), develop and validate a nomogram prediction model. Methods A retrospective analysis was conducted on 300 ICU patients undergoing MV at Haian People's Hospital Affiliated to Nantong University from April 2020 to March 2025. The patients were divided into a AP group (n=71) and a Non-AP (n=229) groups based on AP occurrence during treatment. Independent risk factors were identified using multivariate logistic regression. A nomogram prediction model was constructed using R3.5.1, and model performance was evaluated using receiver operating characteristic (ROC) curves and calibration plots. Results Among 300 ICU-MV patients, 71 (23.7%) cases developed AP. Univariate analysis showed that AP patients had significantly higher proportions of advanced age, impaired consciousness, intermittent cuff pressure monitoring, elevated intra-abdominal pressure, poor oral hygiene, and prolonged MV duration, while subglottic secretion drainage was less frequent (P<0.05). Multivariate analysis confirmed these as independent AP risk factors: advanced age (OR=1.047, 95%CI 1.004-1.093), impaired consciousness (OR=1.468, 95%CI 1.148-1.877), intermittent cuff pressure monitoring (OR=2.496, 95%CI 1.300-4.790), elevated intra-abdominal pressure (OR=1.313, 95%CI 1.027-1.678), poor oral hygiene (OR=1.640, 95%CI 1.244-2.161), and prolonged MV duration (OR=1.233, 95%CI 1.116-1.363) (all P<0.05). The final prediction model was logit(P)= –11.242 + 0.046×Age + 0.384×Consciousness + 0.915×Cuff Pressure Monitoring + 0.272 × Intra-abdominal Pressure + 0.495×Oral Hygiene + 0.209×MV Duration. Hosmer-Lemeshow test indicated good fit (χ2=4.136, DF=8, P=0.825). A nomogram-derived risk score>250 predicted>85% AP probability. Model validation showed a C-index of 0.802, AUC of 0.802 (95%CI 0.752-0.845), sensitivity of 79.01%, specificity of 88.17%, cutoff value of 0.287, Youden's index of 0.672, Brier score of 0.117, and calibration slope of 0.613. Conclusions Advanced age, impaired consciousness, intermittent cuff pressure monitoring, intra-abdominal hypertension, poor oral hygiene, and prolonged MV duration significantly increase AP risk in ICU-MV patients. The developed nomogram demonstrates robust predictive accuracy and clinical applicability.