| Title: |
Lung response to prone positioning in mechanically-ventilated patients with COVID-19 |
| Authors: |
Alessandro Protti; Alessandro Santini; Francesca Pennati; Chiara Chiurazzi; Michele Ferrari; Giacomo E. Iapichino; Luca Carenzo; Francesca Dalla Corte; Ezio Lanza; Nicolò Martinetti; Andrea Aliverti; Maurizio Cecconi |
| Source: |
Critical Care, Vol 26, Iss 1, Pp 1-9 (2022) |
| Publisher Information: |
BMC, 2022. |
| Publication Year: |
2022 |
| Collection: |
LCC:Medical emergencies. Critical care. Intensive care. First aid |
| Subject Terms: |
Acute respiratory distress syndrome; Coronavirus disease 2019; Hypoxia; Mechanical ventilation; Pneumonia; Prone positioning; Medical emergencies. Critical care. Intensive care. First aid; RC86-88.9 |
| Description: |
Abstract Background Prone positioning improves survival in moderate-to-severe acute respiratory distress syndrome (ARDS) unrelated to the novel coronavirus disease (COVID-19). This benefit is probably mediated by a decrease in alveolar collapse and hyperinflation and a more homogeneous distribution of lung aeration, with fewer harms from mechanical ventilation. In this preliminary physiological study we aimed to verify whether prone positioning causes analogue changes in lung aeration in COVID-19. A positive result would support prone positioning even in this other population. Methods Fifteen mechanically-ventilated patients with COVID-19 underwent a lung computed tomography in the supine and prone position with a constant positive end-expiratory pressure (PEEP) within three days of endotracheal intubation. Using quantitative analysis, we measured the volume of the non-aerated, poorly-aerated, well-aerated, and over-aerated compartments and the gas-to-tissue ratio of the ten vertical levels of the lung. In addition, we expressed the heterogeneity of lung aeration with the standardized median absolute deviation of the ten vertical gas-to-tissue ratios, with lower values indicating less heterogeneity. Results By the time of the study, PEEP was 12 (10–14) cmH2O and the PaO2:FiO2 107 (84–173) mmHg in the supine position. With prone positioning, the volume of the non-aerated compartment decreased by 82 (26–147) ml, of the poorly-aerated compartment increased by 82 (53–174) ml, of the normally-aerated compartment did not significantly change, and of the over-aerated compartment decreased by 28 (11–186) ml. In eight (53%) patients, the volume of the over-aerated compartment decreased more than the volume of the non-aerated compartment. The gas-to-tissue ratio of the ten vertical levels of the lung decreased by 0.34 (0.25–0.49) ml/g per level in the supine position and by 0.03 (− 0.11 to 0.14) ml/g in the prone position (p |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
1364-8535 |
| Relation: |
https://doaj.org/toc/1364-8535 |
| DOI: |
10.1186/s13054-022-03996-0 |
| Access URL: |
https://doaj.org/article/738c4faa01ce445a84d0d7d82d3d3ab0 |
| Accession Number: |
edsdoj.738c4faa01ce445a84d0d7d82d3d3ab0 |
| Database: |
Directory of Open Access Journals |