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Scientific article
Open access
English

Effect of body position on the redistribution of regional lung aeration during invasive and non-invasive ventilation of COVID-19 patients

Published inScientific reports, vol. 12, no. 1, 11085
Publication date2022-06-30
First online date2022-06-30
Abstract

Severe COVID-19-related acute respiratory distress syndrome (C-ARDS) requires mechanical ventilation. While this intervention is often performed in the prone position to improve oxygenation, the underlying mechanisms responsible for the improvement in respiratory function during invasive ventilation and awake prone positioning in C-ARDS have not yet been elucidated. In this prospective observational trial, we evaluated the respiratory function of C-ARDS patients while in the supine and prone positions during invasive (n = 13) or non-invasive ventilation (n = 15). The primary endpoint was the positional change in lung regional aeration, assessed with electrical impedance tomography. Secondary endpoints included parameters of ventilation and oxygenation, volumetric capnography, respiratory system mechanics and intrapulmonary shunt fraction. In comparison to the supine position, the prone position significantly increased ventilation distribution in dorsal lung zones for patients under invasive ventilation (53.3 ± 18.3% vs. 43.8 ± 12.3%, percentage of dorsal lung aeration ± standard deviation in prone and supine positions, respectively; p = 0.014); whereas, regional aeration in both positions did not change during non-invasive ventilation (36.4 ± 11.4% vs. 33.7 ± 10.1%; p = 0.43). Prone positioning significantly improved the oxygenation both during invasive and non-invasive ventilation. For invasively ventilated patients reduced intrapulmonary shunt fraction, ventilation dead space and respiratory resistance were observed in the prone position. Oxygenation is improved during non-invasive and invasive ventilation with prone positioning in patients with C-ARDS. Different mechanisms may underly this benefit during these two ventilation modalities, driven by improved distribution of lung regional aeration, intrapulmonary shunt fraction and ventilation-perfusion matching. However, the differences in the severity of C-ARDS may have biased the sensitivity of electrical impedance tomography when comparing positional changes between the protocol groups.

Trial registration: ClinicalTrials.gov (NCT04359407) and Registered 24 April 2020

eng
Keywords
  • COVID-19 / complications
  • COVID-19 / therapy
  • Capnography / methods
  • Humans
  • Lung / diagnostic imaging
  • Noninvasive Ventilation / standards
  • Prone Position
  • Prospective Studies
  • Respiration, Artificial / methods
  • Respiration, Artificial / standards
  • Respiratory Distress Syndrome / therapy
  • Respiratory Distress Syndrome / virology
  • Supine Position
Citation (ISO format)
DOS SANTOS ROCHA, André Alexandre et al. Effect of body position on the redistribution of regional lung aeration during invasive and non-invasive ventilation of COVID-19 patients. In: Scientific reports, 2022, vol. 12, n° 1, p. 11085. doi: 10.1038/s41598-022-15122-9
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Article (Published version)
Identifiers
ISSN of the journal2045-2322
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Technical informations

Creation11/15/2022 12:07:39 PM
First validation07/28/2023 2:01:34 PM
Update time07/28/2023 2:01:34 PM
Status update07/28/2023 2:01:34 PM
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