Physiological response to prone positioning in intubated adults with COVID-19 acute respiratory distress syndrome: a retrospective study.
Détails
Etat: Public
Version: Final published version
Licence: CC BY 4.0
ID Serval
serval:BIB_2736C29422E9
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Physiological response to prone positioning in intubated adults with COVID-19 acute respiratory distress syndrome: a retrospective study.
Périodique
Respiratory research
ISSN
1465-993X (Electronic)
ISSN-L
1465-9921
Statut éditorial
Publié
Date de publication
19/11/2022
Peer-reviewed
Oui
Volume
23
Numéro
1
Pages
320
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Résumé
COVID-19 related acute respiratory distress syndrome (ARDS) has specific characteristics compared to ARDS in other populations. Proning is recommended by analogy with other forms of ARDS, but few data are available regarding its physiological effects in this population. This study aimed to assess the effects of proning on oxygenation parameters (PaO <sub>2</sub> /FiO <sub>2</sub> and alveolo-arterial gradient (Aa-gradient)), blood gas analysis, ventilatory ratio (VR), respiratory system compliance (C <sub>RS</sub> ) and estimated dead space fraction (V <sub>D</sub> /V <sub>T</sub> HB). We also looked for variables associated with treatment failure.
Retrospective monocentric study of intubated COVID-19 ARDS patients managed with an early intubation, low to moderate positive end-expiratory pressure and early proning strategy hospitalized from March 6 to April 30 2020. Blood gas analysis, PaO <sub>2</sub> /FiO <sub>2</sub> , Aa-gradient, VR, C <sub>RS</sub> and V <sub>D</sub> /V <sub>T</sub> HB were compared before and at the end of each proning session with paired t-tests or Wilcoxon tests (p < 0.05 considered as significant). Proportions were assessed using Fischer exact test or Chi square test.
Forty-two patients were included for a total of 191 proning sessions, median duration of 16 (5-36) hours. Considering all sessions, PaO <sub>2</sub> /FiO <sub>2</sub> increased (180 [148-210] vs 107 [90-129] mmHg, p < 0.001) and Aa-gradient decreased (127 [92-176] vs 275 [211-334] mmHg, p < 0.001) with proning. C <sub>RS</sub> (36.2 [30.0-41.8] vs 32.2 [27.5-40.9] ml/cmH <sub>2</sub> O, p = 0.003), VR (2.4 [2.0-2.9] vs 2.3 [1.9-2.8], p = 0.028) and V <sub>D</sub> /V <sub>T</sub> HB (0.72 [0.67-0.76] vs 0.71 [0.65-0.76], p = 0.022) slightly increased. Considering the first proning session, PaO <sub>2</sub> /FiO <sub>2</sub> increased (186 [165-215] vs 104 [94-126] mmHg, p < 0.001) and Aa-gradient decreased (121 [89-160] vs 276 [238-321] mmHg, p < 0.001), while C <sub>RS</sub> , VR and V <sub>D</sub> /V <sub>T</sub> HB were unchanged. Similar variations were observed during the subsequent proning sessions. Among the patients who experienced treatment failure (defined as ICU death or need for extracorporeal membrane oxygenation), fewer expressed a positive response in terms of oxygenation (defined as increase of more than 20% in PaO <sub>2</sub> /FiO <sub>2</sub> ) to the first proning (67 vs 97%, p = 0.020).
Proning in COVID-19 ARDS intubated patients led to an increase in PaO <sub>2</sub> /FiO <sub>2</sub> and a decrease in Aa-gradient if we consider all the sessions together, the first one or the 4 subsequent sessions independently. When considering all sessions, C <sub>RS</sub> increased and VR and V <sub>D</sub> /V <sub>T</sub> HB only slightly increased.
Retrospective monocentric study of intubated COVID-19 ARDS patients managed with an early intubation, low to moderate positive end-expiratory pressure and early proning strategy hospitalized from March 6 to April 30 2020. Blood gas analysis, PaO <sub>2</sub> /FiO <sub>2</sub> , Aa-gradient, VR, C <sub>RS</sub> and V <sub>D</sub> /V <sub>T</sub> HB were compared before and at the end of each proning session with paired t-tests or Wilcoxon tests (p < 0.05 considered as significant). Proportions were assessed using Fischer exact test or Chi square test.
Forty-two patients were included for a total of 191 proning sessions, median duration of 16 (5-36) hours. Considering all sessions, PaO <sub>2</sub> /FiO <sub>2</sub> increased (180 [148-210] vs 107 [90-129] mmHg, p < 0.001) and Aa-gradient decreased (127 [92-176] vs 275 [211-334] mmHg, p < 0.001) with proning. C <sub>RS</sub> (36.2 [30.0-41.8] vs 32.2 [27.5-40.9] ml/cmH <sub>2</sub> O, p = 0.003), VR (2.4 [2.0-2.9] vs 2.3 [1.9-2.8], p = 0.028) and V <sub>D</sub> /V <sub>T</sub> HB (0.72 [0.67-0.76] vs 0.71 [0.65-0.76], p = 0.022) slightly increased. Considering the first proning session, PaO <sub>2</sub> /FiO <sub>2</sub> increased (186 [165-215] vs 104 [94-126] mmHg, p < 0.001) and Aa-gradient decreased (121 [89-160] vs 276 [238-321] mmHg, p < 0.001), while C <sub>RS</sub> , VR and V <sub>D</sub> /V <sub>T</sub> HB were unchanged. Similar variations were observed during the subsequent proning sessions. Among the patients who experienced treatment failure (defined as ICU death or need for extracorporeal membrane oxygenation), fewer expressed a positive response in terms of oxygenation (defined as increase of more than 20% in PaO <sub>2</sub> /FiO <sub>2</sub> ) to the first proning (67 vs 97%, p = 0.020).
Proning in COVID-19 ARDS intubated patients led to an increase in PaO <sub>2</sub> /FiO <sub>2</sub> and a decrease in Aa-gradient if we consider all the sessions together, the first one or the 4 subsequent sessions independently. When considering all sessions, C <sub>RS</sub> increased and VR and V <sub>D</sub> /V <sub>T</sub> HB only slightly increased.
Mots-clé
Humans, Adult, Retrospective Studies, Prone Position, Respiration, Artificial, COVID-19/therapy, Respiratory Distress Syndrome/diagnosis, Respiratory Distress Syndrome/therapy, ARDS, Alveolo-arterial gradient, COVID-19, Dead space, Oxygenation, Prone position, Proning, Respiratory system compliance, Ventilatory ratio
Pubmed
Web of science
Open Access
Oui
Création de la notice
28/11/2022 15:46
Dernière modification de la notice
02/03/2023 7:08
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