Lung response to prone positioning in mechanically-ventilated patients with COVID-19
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 a...
Ausführliche Beschreibung
Autor*in: |
Protti, Alessandro [verfasserIn] |
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Englisch |
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2022 |
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© The Author(s) 2022 |
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Übergeordnetes Werk: |
Enthalten in: Critical care - London : BioMed Central, 1997, 26(2022), 1 vom: 07. Mai |
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volume:26 ; year:2022 ; number:1 ; day:07 ; month:05 |
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DOI / URN: |
10.1186/s13054-022-03996-0 |
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SPR050693832 |
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245 | 1 | 0 | |a Lung response to prone positioning in mechanically-ventilated patients with COVID-19 |
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520 | |a 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) $ cmH_{2} $O and the $ PaO_{2} $:$ FiO_{2} $ 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 < 0.001). The standardized median absolute deviation of the gas-to-tissue ratios of those ten levels decreased in all patients, from 0.55 (0.50–0.71) to 0.20 (0.14–0.27) (p < 0.001). Conclusions In fifteen patients with COVID-19, prone positioning decreased alveolar collapse, hyperinflation, and homogenized lung aeration. A similar response has been observed in other ARDS, where prone positioning improves outcome. Therefore, our data provide a pathophysiological rationale to support prone positioning even in COVID-19. | ||
650 | 4 | |a Acute respiratory distress syndrome |7 (dpeaa)DE-He213 | |
650 | 4 | |a Coronavirus disease 2019 |7 (dpeaa)DE-He213 | |
650 | 4 | |a Hypoxia |7 (dpeaa)DE-He213 | |
650 | 4 | |a Mechanical ventilation |7 (dpeaa)DE-He213 | |
650 | 4 | |a Pneumonia |7 (dpeaa)DE-He213 | |
650 | 4 | |a Prone positioning |7 (dpeaa)DE-He213 | |
700 | 1 | |a Santini, Alessandro |4 aut | |
700 | 1 | |a Pennati, Francesca |4 aut | |
700 | 1 | |a Chiurazzi, Chiara |4 aut | |
700 | 1 | |a Ferrari, Michele |4 aut | |
700 | 1 | |a Iapichino, Giacomo E. |4 aut | |
700 | 1 | |a Carenzo, Luca |4 aut | |
700 | 1 | |a Dalla Corte, Francesca |4 aut | |
700 | 1 | |a Lanza, Ezio |4 aut | |
700 | 1 | |a Martinetti, Nicolò |4 aut | |
700 | 1 | |a Aliverti, Andrea |4 aut | |
700 | 1 | |a Cecconi, Maurizio |4 aut | |
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10.1186/s13054-022-03996-0 doi (DE-627)SPR050693832 (SPR)s13054-022-03996-0-e DE-627 ger DE-627 rakwb eng Protti, Alessandro verfasserin aut Lung response to prone positioning in mechanically-ventilated patients with COVID-19 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2022 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) $ cmH_{2} $O and the $ PaO_{2} $:$ FiO_{2} $ 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 < 0.001). The standardized median absolute deviation of the gas-to-tissue ratios of those ten levels decreased in all patients, from 0.55 (0.50–0.71) to 0.20 (0.14–0.27) (p < 0.001). Conclusions In fifteen patients with COVID-19, prone positioning decreased alveolar collapse, hyperinflation, and homogenized lung aeration. A similar response has been observed in other ARDS, where prone positioning improves outcome. Therefore, our data provide a pathophysiological rationale to support prone positioning even in COVID-19. Acute respiratory distress syndrome (dpeaa)DE-He213 Coronavirus disease 2019 (dpeaa)DE-He213 Hypoxia (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 Pneumonia (dpeaa)DE-He213 Prone positioning (dpeaa)DE-He213 Santini, Alessandro aut Pennati, Francesca aut Chiurazzi, Chiara aut Ferrari, Michele aut Iapichino, Giacomo E. aut Carenzo, Luca aut Dalla Corte, Francesca aut Lanza, Ezio aut Martinetti, Nicolò aut Aliverti, Andrea aut Cecconi, Maurizio aut Enthalten in Critical care London : BioMed Central, 1997 26(2022), 1 vom: 07. Mai (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:26 year:2022 number:1 day:07 month:05 https://dx.doi.org/10.1186/s13054-022-03996-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 26 2022 1 07 05 |
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10.1186/s13054-022-03996-0 doi (DE-627)SPR050693832 (SPR)s13054-022-03996-0-e DE-627 ger DE-627 rakwb eng Protti, Alessandro verfasserin aut Lung response to prone positioning in mechanically-ventilated patients with COVID-19 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2022 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) $ cmH_{2} $O and the $ PaO_{2} $:$ FiO_{2} $ 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 < 0.001). The standardized median absolute deviation of the gas-to-tissue ratios of those ten levels decreased in all patients, from 0.55 (0.50–0.71) to 0.20 (0.14–0.27) (p < 0.001). Conclusions In fifteen patients with COVID-19, prone positioning decreased alveolar collapse, hyperinflation, and homogenized lung aeration. A similar response has been observed in other ARDS, where prone positioning improves outcome. Therefore, our data provide a pathophysiological rationale to support prone positioning even in COVID-19. Acute respiratory distress syndrome (dpeaa)DE-He213 Coronavirus disease 2019 (dpeaa)DE-He213 Hypoxia (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 Pneumonia (dpeaa)DE-He213 Prone positioning (dpeaa)DE-He213 Santini, Alessandro aut Pennati, Francesca aut Chiurazzi, Chiara aut Ferrari, Michele aut Iapichino, Giacomo E. aut Carenzo, Luca aut Dalla Corte, Francesca aut Lanza, Ezio aut Martinetti, Nicolò aut Aliverti, Andrea aut Cecconi, Maurizio aut Enthalten in Critical care London : BioMed Central, 1997 26(2022), 1 vom: 07. Mai (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:26 year:2022 number:1 day:07 month:05 https://dx.doi.org/10.1186/s13054-022-03996-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 26 2022 1 07 05 |
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10.1186/s13054-022-03996-0 doi (DE-627)SPR050693832 (SPR)s13054-022-03996-0-e DE-627 ger DE-627 rakwb eng Protti, Alessandro verfasserin aut Lung response to prone positioning in mechanically-ventilated patients with COVID-19 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2022 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) $ cmH_{2} $O and the $ PaO_{2} $:$ FiO_{2} $ 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 < 0.001). The standardized median absolute deviation of the gas-to-tissue ratios of those ten levels decreased in all patients, from 0.55 (0.50–0.71) to 0.20 (0.14–0.27) (p < 0.001). Conclusions In fifteen patients with COVID-19, prone positioning decreased alveolar collapse, hyperinflation, and homogenized lung aeration. A similar response has been observed in other ARDS, where prone positioning improves outcome. Therefore, our data provide a pathophysiological rationale to support prone positioning even in COVID-19. Acute respiratory distress syndrome (dpeaa)DE-He213 Coronavirus disease 2019 (dpeaa)DE-He213 Hypoxia (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 Pneumonia (dpeaa)DE-He213 Prone positioning (dpeaa)DE-He213 Santini, Alessandro aut Pennati, Francesca aut Chiurazzi, Chiara aut Ferrari, Michele aut Iapichino, Giacomo E. aut Carenzo, Luca aut Dalla Corte, Francesca aut Lanza, Ezio aut Martinetti, Nicolò aut Aliverti, Andrea aut Cecconi, Maurizio aut Enthalten in Critical care London : BioMed Central, 1997 26(2022), 1 vom: 07. Mai (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:26 year:2022 number:1 day:07 month:05 https://dx.doi.org/10.1186/s13054-022-03996-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 26 2022 1 07 05 |
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10.1186/s13054-022-03996-0 doi (DE-627)SPR050693832 (SPR)s13054-022-03996-0-e DE-627 ger DE-627 rakwb eng Protti, Alessandro verfasserin aut Lung response to prone positioning in mechanically-ventilated patients with COVID-19 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2022 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) $ cmH_{2} $O and the $ PaO_{2} $:$ FiO_{2} $ 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 < 0.001). The standardized median absolute deviation of the gas-to-tissue ratios of those ten levels decreased in all patients, from 0.55 (0.50–0.71) to 0.20 (0.14–0.27) (p < 0.001). Conclusions In fifteen patients with COVID-19, prone positioning decreased alveolar collapse, hyperinflation, and homogenized lung aeration. A similar response has been observed in other ARDS, where prone positioning improves outcome. Therefore, our data provide a pathophysiological rationale to support prone positioning even in COVID-19. Acute respiratory distress syndrome (dpeaa)DE-He213 Coronavirus disease 2019 (dpeaa)DE-He213 Hypoxia (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 Pneumonia (dpeaa)DE-He213 Prone positioning (dpeaa)DE-He213 Santini, Alessandro aut Pennati, Francesca aut Chiurazzi, Chiara aut Ferrari, Michele aut Iapichino, Giacomo E. aut Carenzo, Luca aut Dalla Corte, Francesca aut Lanza, Ezio aut Martinetti, Nicolò aut Aliverti, Andrea aut Cecconi, Maurizio aut Enthalten in Critical care London : BioMed Central, 1997 26(2022), 1 vom: 07. Mai (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:26 year:2022 number:1 day:07 month:05 https://dx.doi.org/10.1186/s13054-022-03996-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 26 2022 1 07 05 |
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10.1186/s13054-022-03996-0 doi (DE-627)SPR050693832 (SPR)s13054-022-03996-0-e DE-627 ger DE-627 rakwb eng Protti, Alessandro verfasserin aut Lung response to prone positioning in mechanically-ventilated patients with COVID-19 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2022 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) $ cmH_{2} $O and the $ PaO_{2} $:$ FiO_{2} $ 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 < 0.001). The standardized median absolute deviation of the gas-to-tissue ratios of those ten levels decreased in all patients, from 0.55 (0.50–0.71) to 0.20 (0.14–0.27) (p < 0.001). Conclusions In fifteen patients with COVID-19, prone positioning decreased alveolar collapse, hyperinflation, and homogenized lung aeration. A similar response has been observed in other ARDS, where prone positioning improves outcome. Therefore, our data provide a pathophysiological rationale to support prone positioning even in COVID-19. Acute respiratory distress syndrome (dpeaa)DE-He213 Coronavirus disease 2019 (dpeaa)DE-He213 Hypoxia (dpeaa)DE-He213 Mechanical ventilation (dpeaa)DE-He213 Pneumonia (dpeaa)DE-He213 Prone positioning (dpeaa)DE-He213 Santini, Alessandro aut Pennati, Francesca aut Chiurazzi, Chiara aut Ferrari, Michele aut Iapichino, Giacomo E. aut Carenzo, Luca aut Dalla Corte, Francesca aut Lanza, Ezio aut Martinetti, Nicolò aut Aliverti, Andrea aut Cecconi, Maurizio aut Enthalten in Critical care London : BioMed Central, 1997 26(2022), 1 vom: 07. Mai (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:26 year:2022 number:1 day:07 month:05 https://dx.doi.org/10.1186/s13054-022-03996-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 26 2022 1 07 05 |
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Protti, Alessandro Santini, Alessandro Pennati, Francesca Chiurazzi, Chiara Ferrari, Michele Iapichino, Giacomo E. Carenzo, Luca Dalla Corte, Francesca Lanza, Ezio Martinetti, Nicolò Aliverti, Andrea Cecconi, Maurizio |
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lung response to prone positioning in mechanically-ventilated patients with covid-19 |
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Lung response to prone positioning in mechanically-ventilated patients with COVID-19 |
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) $ cmH_{2} $O and the $ PaO_{2} $:$ FiO_{2} $ 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 < 0.001). The standardized median absolute deviation of the gas-to-tissue ratios of those ten levels decreased in all patients, from 0.55 (0.50–0.71) to 0.20 (0.14–0.27) (p < 0.001). Conclusions In fifteen patients with COVID-19, prone positioning decreased alveolar collapse, hyperinflation, and homogenized lung aeration. A similar response has been observed in other ARDS, where prone positioning improves outcome. Therefore, our data provide a pathophysiological rationale to support prone positioning even in COVID-19. © The Author(s) 2022 |
abstractGer |
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) $ cmH_{2} $O and the $ PaO_{2} $:$ FiO_{2} $ 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 < 0.001). The standardized median absolute deviation of the gas-to-tissue ratios of those ten levels decreased in all patients, from 0.55 (0.50–0.71) to 0.20 (0.14–0.27) (p < 0.001). Conclusions In fifteen patients with COVID-19, prone positioning decreased alveolar collapse, hyperinflation, and homogenized lung aeration. A similar response has been observed in other ARDS, where prone positioning improves outcome. Therefore, our data provide a pathophysiological rationale to support prone positioning even in COVID-19. © The Author(s) 2022 |
abstract_unstemmed |
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) $ cmH_{2} $O and the $ PaO_{2} $:$ FiO_{2} $ 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 < 0.001). The standardized median absolute deviation of the gas-to-tissue ratios of those ten levels decreased in all patients, from 0.55 (0.50–0.71) to 0.20 (0.14–0.27) (p < 0.001). Conclusions In fifteen patients with COVID-19, prone positioning decreased alveolar collapse, hyperinflation, and homogenized lung aeration. A similar response has been observed in other ARDS, where prone positioning improves outcome. Therefore, our data provide a pathophysiological rationale to support prone positioning even in COVID-19. © The Author(s) 2022 |
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Lung response to prone positioning in mechanically-ventilated patients with COVID-19 |
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https://dx.doi.org/10.1186/s13054-022-03996-0 |
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Santini, Alessandro Pennati, Francesca Chiurazzi, Chiara Ferrari, Michele Iapichino, Giacomo E. Carenzo, Luca Dalla Corte, Francesca Lanza, Ezio Martinetti, Nicolò Aliverti, Andrea Cecconi, Maurizio |
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Santini, Alessandro Pennati, Francesca Chiurazzi, Chiara Ferrari, Michele Iapichino, Giacomo E. Carenzo, Luca Dalla Corte, Francesca Lanza, Ezio Martinetti, Nicolò Aliverti, Andrea Cecconi, Maurizio |
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