Effect of the prone position on recruitability in acute respiratory distress syndrome due to COVID-19 pneumonia.

OBJECTIVE: This study aimed to assess the effect of prone position on oxygenation and lung recruitability in patients with acute respiratory distress syndrome due to COVID-19 receiving invasive mechanical ventilation. METHODS: This prospective study was conducted in the intensive care unit between December 10, 2021, and February 10, 2022. We included 25 patients admitted to our intensive care unit with acute respiratory distress syndrome due to COVID-19 who had undergone prone position. We measured the respiratory system compliance, recruitment to inflation ratio, and PaO2/FiO2 ratio during the baseline supine, prone, and resupine positions. The recruitment to inflation ratio was used to assess the potential for lung recruitability. RESULTS: In the prone position, PaO2/FiO2 increased from 82.7 to 164.4 mmHg (p<0.001) with an increase in respiratory system compliance (p=0.003). PaO2/FiO2 decreased to 117 mmHg (p=0.015) in the resupine with no change in respiratory system compliance (p=0.097). The recruitment to inflation ratio did not change in the prone and resupine positions (p=0.198 and p=0.621, respectively). In all patients, the median value of respiratory system compliance during supine was 26 mL/cmH2O. In patients with respiratory system compliance<26 mL/cmH2O (n=12), respiratory system compliance increased and recruitment to inflation decreased from supine to prone positions (p=0.008 and p=0.040, respectively), whereas they did not change in those with respiratory system compliance ≥26 mL/cmH2O8 (n=13) (p=0.279 and p=0.550, respectively) (ClinicalTrials registration number: NCT05150847). CONCLUSION: In the prone position, in addition to the oxygenation benefit in all patients, we detected lung recruitment based on the change in the recruitment to inflation ratio with an increase in respiratory system compliance only in acute respiratory distress syndrome due to COVID-19 patients who have <26 mL/cmH2O baseline supine respiratory compliance.

Pneumothorax and Pneumomediastinum in Patients admitted to Intensive Care Unit with COVID-19 Pneumonia: A Single-Center Retrospective Analysis.

Objectives: This study aimed to examine the frequency, and clinical features of pneumothorax and pneumomediastinum cases in patients admitted to the intensive care unit due to coronavirus disease-19 (COVID- 19) pneumonia. Methods: We retrospectively screened the COVID-19 cases hospitalized in our intensive care unit between March 11, 2020, and January 11, 2022. Patients diagnosed as pneumothorax or pneumomediastinum were determined. The frequency and clinical features of pneumothorax and pneumomediastinum were investigated. Results: Seven hundred and twenty patients hospitalized in our intensive care unit between March 11, 2020, and January 11, 2022 were screened. Twenty-four (3.3%) patients had pneumothorax or pneumomediastinum. Pneumothorax occurred 17 patients (70%), and pneumomediastinum in 14 patients (58%). The number of patients who developed pneumomediastinum and pneumothorax together was 7 (29%). COVID-19-associated pneumothorax tended to be unilateral (n=16) and right-sided (n=11). In 18 (75%) patients, pneumothorax or pneumomediastinum developed during invasive mechanical ventilation, 5 (20.8%) patients during non-invasive mechanical ventilation. One patient developed pneumothorax when mechanical ventilation was not applied. The mortality rate at 60 days was 75% (n=18) in patients who were admitted to the intensive care unit with COVID- 19 and developed pneumomediastinum or pneumothorax. Conclusion: Pneumothorax and pneumomediastinum are complications of COVID-19 pneumonia with high mortality rates. (English) [ FROM AUTHOR] Amaç: Bu çalışmada, koronavirüs hastalığı-19 (COVID-19) pnömonisi nedeniyle üçüncü basamak yoğun bakım ünitesine başvuran hastalarda gelişen pnömotoraks ve pnömomediastinum sıklığının ve klinik özelliklerinin incelenmesi amaçlandı. Yöntem: Yoğun bakım ünitesinde, 11 Mart 2020 ile 11 Ocak 2022 tarihleri arasında yatan COVID-19 hastaları geriye dönük olarak incelendi, pnömotoraks ve pnömomediastinum tanıları alan hastalar belirlendi. Pnömotoraks ve pnömomediastinum sıklığı ile klinik özellikleri araştırıldı. Bulgular: Yoğun bakım ünitesinde 11 Mart 2020 ile 11 Ocak 2022 tarihleri arasında yatan 720 hasta tarandı. Yirmi dört hastanın pnömotoraks veya pnömomediastinum olduğu izlendi (%3,3). On yedi (%70) hastada pnömotoraks, 14 (%58) hastada ise pnömomediastinum izlendi. Pnömomediastinum ve pnömotoraksın birlikte geliştiği hasta sayısı 7 (%29) idi. COVID-19 ile ilişkili pnömotoraks tek taraflı (n=16) ve sağ taraflı olma (n=11) eğiliminde idi. Hastaların 18’i (%75) pnömotoraks veya pnömomediastinum gelişimi sırasında invaziv mekanik ventilasyon, 5’ine (%20,8) noninvaziv mekanik ventilasyon uygulanmaktaydı. Bir hastada mekanik ventilasyon uygulanmıyorken pnömotoraks gelişti. COVID-19 hastalığı ile yoğun bakıma yatan, pnömotoraks veya pnömomediastinum gelişen hastalarda 60. günde ölüm oranı %75 (n=18) idi. Sonuç: Pnömotoraks ve pnömomediastinum COVID-19’a bağlı pnömoni hastalarında gelişebilen mortalitesi yüksek komplikasyonlardır. (Turkish) [ FROM AUTHOR] Copyright of Journal of the Society of Thoracic Carido-Vascular Anaesthesia & Intensive Care is the property of Gogus Kalp Damar Anestezi ve Yogun Bakim Dernegi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)