Prone Position Improves End-Expiratory Lung Volumes in COVID-19 Associated Acute Respiratory Distress Syndrome: An Observational Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Acute Respiratory Distress Syndrome
- Sponsor
- Istanbul University - Cerrahpasa (IUC)
- Enrollment
- 43
- Locations
- 1
- Primary Endpoint
- Partial Pressure of Oxygen/ Fraction of Inspired Oxygen
- Status
- Completed
- Last Updated
- 4 years ago
Overview
Brief Summary
Covid-19 associated Acute Respiratory Distress Syndrome (ARDS) may present with profound hypoxemia not fully explained with pulmonary infiltrates. Accordingly, how prone positioning improves oxygenation in these patients is not fully known. The investigators conducted a study among patients with severe Covid-19 ARDS receiving prone position for at least 16 hours. End Expiratory Lung Volume (EELV) was measured with Nitrogen wash-in/wash-out technique before (Supine Position 1- SP1), during (Prone Position - PP) and after (Supine Position 2 - SP2) prone positioning.
Detailed Description
After initiation of invasive mechanical ventilation, initial ventilator settings were performed by the attending physician. These settings include titration of best PEEP to promote oxygenation if Spo2 \<92% despite a Fio2 higher than 80% or best compliance that do not jeopardize oxygenation if Fio2 is between 50-80% and Spo2 \>92%. After a period of 30 minutes for stabilisation, the first set of measurements were done in the SP1 position. Afterwards, the patient was turned to prone position with the same PEEP (which was unchanged throughout the study period) and measurements were repeated every four hours until the patient was reverted back to SP2. Eventually, there were 7 measurements in total. (SP1, PP0, PP4, PP8, PP12, PP16, SP2). Dead space ventilation and shunt fraction calculations were made based on central venous blood gas measurements and oxygen consumption and carbon dioxide production at the relevant timepoint.
Investigators
Olcay Dilken
Principal Investigator
Istanbul University - Cerrahpasa (IUC)
Eligibility Criteria
Inclusion Criteria
- •Patients were considered eligible if they met the Berlin definition criteria for ARDS and intubated due to increased work of breathing and/or worsening hypoxemia. All patients had a positive Covid-19 real time Polymerase Chain Reaction test
Exclusion Criteria
- •Exclusion criteria were; age \< 18 years, ARDS resulting from other risk factors, presence of chest drainage tubes, tracheostomy, pneumomediastinum, hemodynamic instability (systolic blood pressure \< 100 mmHg, lactate \> 2 mmol/l, or an increase in lactate concentrations for 20% in two consecutive blood gas analysis within 2 hours interval) and suspicion or confirmed pulmonary emboli.
Outcomes
Primary Outcomes
Partial Pressure of Oxygen/ Fraction of Inspired Oxygen
Time Frame: 1 day
Oxygenation
End Expiratory Lung Volume
Time Frame: 1 day
Oxygenation
Secondary Outcomes
- Dead Space Ventilation(1 day)
- Lung Compliance(1 day)