Prone positioning may increase lung overdistension in COVID-19-induced ARDS
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Citações na Scopus
4
Tipo de produção
article
Data de publicação
2022
Título da Revista
ISSN da Revista
Título do Volume
Editora
NATURE PORTFOLIO
Autores
OTAHAL, Michal
MLCEK, Mikulas
BORGES, Joao Batista
HLADIK, Dominik
KURISCAK, Eduard
TEJKL, Leos
KITTNAR, Otomar
Citação
SCIENTIFIC REPORTS, v.12, n.1, article ID 16528, 6p, 2022
Resumo
Real-time effects of changing body position and positive end-expiratory pressure (PEEP) on regional lung overdistension and collapse in individual patients remain largely unknown and not timely monitored. The aim of this study was to individualize PEEP in supine and prone body positions seeking to reduce lung collapse and overdistension in mechanically ventilated patients with coronavirus disease (COVID-19)-induced acute respiratory distress syndrome (ARDS). We hypothesized that prone positioning with bedside titrated PEEP would provide attenuation of both overdistension and collapse. In this prospective observational study, patients with COVID-19-induced ARDS under mechanical ventilation were included. We used electrical impedance tomography (EIT) with decremental PEEP titration algorithm (PEEPEIT-titration), which provides information on regional lung overdistension and collapse, along with global respiratory system compliance, to individualize PEEP and body position. PEEPEIT-titration in supine position followed by PEEPEIT-titration in prone position were performed. Immediately before each PEEPEIT-titration, the same lung recruitment maneuver was performed: 2 min of PEEP 24 cmH(2)O and driving pressure of 15 cmH(2)O. Forty-two PEEPEIT-titration were performed in ten patients (21 pairs supine and prone positions). We have found larger % of overdistension along the PEEP titration in prone than supine position (P = 0.042). A larger % of collapse along the PEEP titration was found in supine than prone position (P = 0.037). A smaller respiratory system compliance was found in prone than supine position (P < 0.0005). In patients with COVID-19-induced ARDS, prone body position, when compared with supine body position, decreased lung collapse at low PEEP levels, but increased lung overdistension at PEEP levels greater than 10 cm H2O. Trial registration number: NCT04460859.
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Referências
- Alhazzani W, 2021, CRIT CARE MED, V49, pE219, DOI 10.1097/CCM.0000000000004899
- Blanch L, 1997, INTENS CARE MED, V23, P1033, DOI 10.1007/s001340050453
- Coppo A, 2020, LANCET RESP MED, V8, P765, DOI 10.1016/S2213-2600(20)30268-X
- Costa ELV, 2009, INTENS CARE MED, V35, P1132, DOI 10.1007/s00134-009-1447-y
- Ferrando C, 2020, CRIT CARE, V24, DOI 10.1186/s13054-020-03314-6
- Ferrando C, 2020, INTENS CARE MED, V46, P2200, DOI 10.1007/s00134-020-06192-2
- Fridrich P, 1996, ANESTH ANALG, V83, P1206, DOI 10.1097/00000539-199612000-00013
- Grasselli G, 2020, JAMA INTERN MED, V180, P1345, DOI 10.1001/jamainternmed.2020.3539
- Guerin C, 2020, INTENS CARE MED, V46, P2385, DOI 10.1007/s00134-020-06306-w
- Johannigman JA, 2001, J TRAUMA, V50, P589, DOI 10.1097/00005373-200104000-00001
- Jozwiak M, 2013, AM J RESP CRIT CARE, V188, P1428, DOI 10.1164/rccm.201303-0593OC
- Kallet Richard H, 2003, Respir Care Clin N Am, V9, P297, DOI 10.1016/S1078-5337(03)00040-6
- Kallet RH, 2015, RESP CARE, V60, P1660, DOI 10.4187/respcare.04271
- Lim CM, 2001, INTENS CARE MED, V27, P477, DOI 10.1007/s001340000848
- Mlcek M, 2021, BMC PULM MED, V21, DOI 10.1186/s12890-021-01501-x
- Nasa P, 2021, CRIT CARE, V25, DOI 10.1186/s13054-021-03491-y
- Offner PJ, 2000, J TRAUMA, V48, P224, DOI 10.1097/00005373-200002000-00004
- Osuchowski MF, 2021, LANCET RESP MED, V9, P622, DOI 10.1016/S2213-2600(21)00218-6
- Patel BV, 2021, INTENS CARE MED, V47, P549, DOI 10.1007/s00134-021-06389-z
- Ranieri VM, 2012, JAMA-J AM MED ASSOC, V307, P2526, DOI 10.1001/jama.2012.5669
- Servillo G, 1997, INTENS CARE MED, V23, P1219, DOI 10.1007/s001340050489
- Stocker R, 1997, CHEST, V111, P1008, DOI 10.1378/chest.111.4.1008