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1.
Sci Rep ; 12(1): 11085, 2022 Jun 30.
Article in English | MEDLINE | ID: covidwho-1908294

ABSTRACT

Severe COVID-19-related acute respiratory distress syndrome (C-ARDS) requires mechanical ventilation. While this intervention is often performed in the prone position to improve oxygenation, the underlying mechanisms responsible for the improvement in respiratory function during invasive ventilation and awake prone positioning in C-ARDS have not yet been elucidated. In this prospective observational trial, we evaluated the respiratory function of C-ARDS patients while in the supine and prone positions during invasive (n = 13) or non-invasive ventilation (n = 15). The primary endpoint was the positional change in lung regional aeration, assessed with electrical impedance tomography. Secondary endpoints included parameters of ventilation and oxygenation, volumetric capnography, respiratory system mechanics and intrapulmonary shunt fraction. In comparison to the supine position, the prone position significantly increased ventilation distribution in dorsal lung zones for patients under invasive ventilation (53.3 ± 18.3% vs. 43.8 ± 12.3%, percentage of dorsal lung aeration ± standard deviation in prone and supine positions, respectively; p = 0.014); whereas, regional aeration in both positions did not change during non-invasive ventilation (36.4 ± 11.4% vs. 33.7 ± 10.1%; p = 0.43). Prone positioning significantly improved the oxygenation both during invasive and non-invasive ventilation. For invasively ventilated patients reduced intrapulmonary shunt fraction, ventilation dead space and respiratory resistance were observed in the prone position. Oxygenation is improved during non-invasive and invasive ventilation with prone positioning in patients with C-ARDS. Different mechanisms may underly this benefit during these two ventilation modalities, driven by improved distribution of lung regional aeration, intrapulmonary shunt fraction and ventilation-perfusion matching. However, the differences in the severity of C-ARDS may have biased the sensitivity of electrical impedance tomography when comparing positional changes between the protocol groups.Trial registration: ClinicalTrials.gov (NCT04359407) and Registered 24 April 2020, https://clinicaltrials.gov/ct2/show/NCT04359407 .


Subject(s)
COVID-19/therapy , Noninvasive Ventilation , Respiration, Artificial/methods , Respiratory Distress Syndrome/therapy , COVID-19/complications , Capnography/methods , Humans , Lung/diagnostic imaging , Noninvasive Ventilation/standards , Prone Position , Prospective Studies , Respiration, Artificial/standards , Respiratory Distress Syndrome/virology , Supine Position
2.
Emerg Med J ; 38(7): 361-363, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1376518

ABSTRACT

A short cut review was carried out to establish the diagnostic characteristics of alveolar dead space fraction (AVDSf) in the diagnosis of pulmonary embolism (PE). This is calculated from the arterial and end-tidal CO2 Three papers were selected to answer the clinical question. The author, study type, relevant outcomes, results and weaknesses are tabulated. It is concluded that there is good evidence to support the use of AVDSf within a clinical prediction model to exclude a PE in patients when there is a low pretest probability. However, the specificity is not sufficient to support it as a 'rule in' test.


Subject(s)
COVID-19/complications , Capnography/methods , Carbon Dioxide/analysis , Pulmonary Embolism/diagnosis , Aged , COVID-19/diagnosis , Capnography/instrumentation , Carbon Dioxide/blood , Chest Pain/etiology , Cough/etiology , Dyspnea/etiology , Fever/etiology , Humans , Male , Pulmonary Embolism/blood , Pulmonary Embolism/physiopathology
3.
Emerg Med J ; 38(7): 361-363, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1280440

ABSTRACT

A short cut review was carried out to establish the diagnostic characteristics of alveolar dead space fraction (AVDSf) in the diagnosis of pulmonary embolism (PE). This is calculated from the arterial and end-tidal CO2 Three papers were selected to answer the clinical question. The author, study type, relevant outcomes, results and weaknesses are tabulated. It is concluded that there is good evidence to support the use of AVDSf within a clinical prediction model to exclude a PE in patients when there is a low pretest probability. However, the specificity is not sufficient to support it as a 'rule in' test.


Subject(s)
COVID-19/complications , Capnography/methods , Carbon Dioxide/analysis , Pulmonary Embolism/diagnosis , Aged , COVID-19/diagnosis , Capnography/instrumentation , Carbon Dioxide/blood , Chest Pain/etiology , Cough/etiology , Dyspnea/etiology , Fever/etiology , Humans , Male , Pulmonary Embolism/blood , Pulmonary Embolism/physiopathology
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