Physiological Effects and Safety of Bed Verticalization in Patients with Acute Respiratory Distress Syndrome

BACKGROUND : Prone positioning has been proposed as a key aspect of care in acute respiratory distress syndrome (ARDS), more than ever with emergence of COVID-19 pandemic, but sometimes at the cost of burdensome procedure and serious adverse events. Bed verticalization (standing upright) could be an efficient alternative to prone position. Semi-seated position (45-degree head-up, 45-degree legs-down) have already been studied and shew promising results, but to our knowledge no study has evaluated the mechanical and physiological impacts of complete patient verticalization during ARDS. The objective was to evaluate the safety and physiological effects of bed verticalization of sedated and ventilated patients with ARDS. METHODS : Patients were gradually verticalized, using a dedicated bed, at 0°, 30°, 60° and 90° by steps of 30 minutes. At each position step, multiparametric measurements were performed, including hemodynamic data with pulmonary artery catheter, ventilatory parameters, arterial and central veinous gasometry, end-expiratory lung volume, esophageal pressures, and electrical impedance tomography. All these measurements were set to assess effects of verticalization on hemodynamics, ventilatory mechanics and hematosis.

Patients’ families: the forgotten people of the health crisis

The sudden influx of seriously ill patients, as well as the healthcare precautions required during the severe acute respiratory syndrome coronavirus 2 pandemic, have totally disrupted the organisation of the intensive care units. Visits were drastically restricted, even forbidden or made impossible for transferred patients from other regions. However, their benefits have long been recognised for them, as well as for their loved ones. Many services have introduced new means of communication (smartphone, videoconferencing, pre-recorded message, etc.) between the patient, their relatives and the medical and/or paramedical staff. Their implementation will never replace the presence of relatives, but could be an asset in the event of new restricted visits and remains to be evaluated in the long term. © 2020 z L'afflux brutal de patients dans un état grave, ainsi que les précautions sanitaires requises par la pandémie de severe acute respiratory syndrome coronavirus 2 ont totalement chamboulé l'organisation des services de réanimation z Les visites ont été drastiquement restreintes, voire totalement interdites ou rendues impossible pour les patients transférés depuis d'autres régions z Le bénéfice de celles-ci pour les malades, ainsi d'ailleurs que pour leurs proches, est pourtant reconnu de longue date z De nombreux services ont utilisé de nouveaux moyens de communication (smartphone, visioconférence, message préenregistré, etc.) entre le patient, sa famille et le corps médical et/ou paramédical z Leur mise en œuvre ne remplacera jamais la présence des proches, mais pourrait être un atout en cas de nouvelle restriction des visites et reste à évaluer sur le long terme. © 2020