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EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-331574


Background: Lung ultrasound (LUS) is a validated tool for the management of coronavirus disease 2019 (COVID-19)-related pneumonia. An awake prone positioning (PP) improves oxygenation and outcomes in COVID-19 non-intubated patients, but its tolerance remains an issue. A chair positioning (CP) may have beneficial effects on oxygenation and lung aeration. Thus, CP could be an easier alternative to PP. This study assessed the effects of a CP session on oxygenation (using SpO 2 FiO 2 ratio) and lung aeration (using lung reaeration score) changes in non-intubated COVID-19 patients. Methods: An observational multicenter study was conducted in three university hospital intensive care units (ICUs). We retrospectively analyzed prospectively collected data from LUS exams performed before and after a CP session in non-intubated COVID-19 patients. Patients were divided into groups of responders or non-responders in terms of oxygenation and lung aeration. Results: Of the 33 patients included in the study, 14 (44%) were oxygenation non-responders and 18 (56%) were oxygenation responders, and 13 (40.6%) and 19 (59.4%) patients were classified as lung aeration non-responders and responders, respectively. Changes in oxygenation and lung aeration before and after a CP session were not correlated (Pearson’s r = -0.19, p = 0.3, 95% CI: -0.5–0.17). The reaeration scores did not differ between oxygenation responders and non-responders (1 [-0.75–3.75] vs. 4, [-1–6], p = 0.41). The LUS score was significantly correlated with SpO 2 FiO 2 ratio before a CP session (Pearson’s r = 0.37, p = 0.04, 95% CI: 0.03–0.64) but not after (Pearson’s r = 0.17, p = 0.35, 95% CI: -0.19–0.50). Conclusion: A CP session was associated with improved oxygenation and lung aeration in more than half of the non-intubated COVID-19 patients. However, oxygenation and lung aeration changes were not associated, suggesting that a CP session induces a ventilation:perfusion matching alteration.

Trials ; 22(1): 692, 2021 Oct 11.
Article in English | MEDLINE | ID: covidwho-1463262


BACKGROUND: Acute respiratory distress syndrome (ARDS) is a severe complication of COVID-19 pneumonia, with a mortality rate amounting to 34-50% in moderate and severe ARDS, and is associated with prolonged duration of invasive mechanical ventilation. Such as in non-COVID ARDS, harmful mechanical ventilation settings might be associated with worse outcomes. Reducing the tidal volume down to 4 mL kg-1 of predicted body weight (PBW) to provide ultra-low tidal volume ventilation (ULTV) is an appealing technique to minimize ventilator-inducted lung injury. Furthermore, in the context of a worldwide pandemic, it does not require any additional material and consumables and may be applied in low- to middle-income countries. We hypothesized that ULTV without extracorporeal circulation is a credible option to reduce COVID-19-related ARDS mortality and duration of mechanical ventilation. METHODS: The VT4COVID study is a randomized, multi-centric prospective open-labeled, controlled superiority trial. Adult patients admitted in the intensive care unit with COVID-19-related mild to severe ARDS defined by a PaO2/FiO2 ratio ≤ 150 mmHg under invasive mechanical ventilation for less than 48 h, and consent to participate to the study will be eligible. Patients will be randomized into two balanced parallels groups, at a 1:1 ratio. The control group will be ventilated with protective ventilation settings (tidal volume 6 mL kg-1 PBW), and the intervention group will be ventilated with ULTV (tidal volume 4 mL kg-1 PBW). The primary outcome is a composite score based on 90-day all-cause mortality as a prioritized criterion and the number of ventilator-free days at day 60 after inclusion. The randomization list will be stratified by site of recruitment and generated using random blocks of sizes 4 and 6. Data will be analyzed using intention-to-treat principles. DISCUSSION: The purpose of this manuscript is to provide primary publication of study protocol to prevent selective reporting of outcomes, data-driven analysis, and to increase transparency. Enrollment of patients in the study is ongoing. TRIAL REGISTRATION: NCT04349618 . Registered on April 16, 2020.

COVID-19 , Respiratory Distress Syndrome , Adult , Extracorporeal Circulation , Humans , Prospective Studies , Randomized Controlled Trials as Topic , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/therapy , SARS-CoV-2