Unable to write in log file ../../bases/logs/gimorg/logerror.txt Physiologic Effects of the Awake Prone Position Combined With High-Flow Nasal Oxygen on Gas Exchange and Work of Breathing in Patients With Severe COVID-19 Pneumonia: A Randomized Crossover Trial. | Crit Care Explor;4(12): e0805, 2022 Dec. | MEDLINE
Physiologic Effects of the Awake Prone Position Combined With High-Flow Nasal Oxygen on Gas Exchange and Work of Breathing in Patients With Severe COVID-19 Pneumonia: A Randomized Crossover Trial.
Lehingue, Samuel; Allardet-Servent, Jérôme; Ferdani, Anne; Hraeich, Sami; Forel, Jean-Marie; Arnal, Jean-Michel; Prud'homme, Eloi; Penaranda, Guillaume; Bourenne, Jeremy; Monnet, Olivier; Gainnier, Marc; Cantais, Emmanuel.
  • Lehingue S; Department of Intensive Care, Hôpital Saint Joseph, Marseille, France.
  • Allardet-Servent J; Department of Intensive Care, Hôpital Européen Marseille, Marseille, France.
  • Ferdani A; Department of Intensive Care, Centre Hospitalier d'Aix-en-Provence, Aix-en-Provence, France.
  • Hraeich S; Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France.
  • Forel JM; Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France.
  • Arnal JM; Multipurpose Intensive Care Service, Hôpital Sainte Musse, Toulon, France.
  • Prud'homme E; Service des Maladies Respiratoires, Centre Hospitalier d'Aix-en-Provence, Aix-en-Provence, France.
  • Penaranda G; Biostastistic, Laboratoire Européen Alphabio, Marseille, France.
  • Bourenne J; Emergency and Critical Care Medicine, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France.
  • Monnet O; Department of Radiology, Hôpital Saint Joseph, Marseille, France.
  • Gainnier M; Emergency and Critical Care Medicine, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France.
  • Cantais E; Department of Intensive Care, Hôpital Saint Joseph, Marseille, France.
Crit Care Explor ; 4(12): e0805, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2190842
ABSTRACT
To determine the effect of the awake prone position (APP) on gas exchange and the work of breathing in spontaneously breathing patients with COVID-19-associated acute hypoxemic respiratory failure (AHRF) supported by high-flow nasal oxygen.

DESIGN:

Prospective randomized physiologic crossover multicenter trial. SETTINGS Four ICUs in Marseille, France. PATIENTS Seventeen patients with laboratory-confirmed COVID-19 pneumonia and Pao2/Fio2 less than or equal to 300 mm Hg while treated with high-flow nasal cannula oxygen therapy.

INTERVENTIONS:

Periods of APP and semirecumbent position (SRP) were randomly applied for 2 hours and separated by a 2-hour washout period. MEASUREMENTS AND MAIN

RESULTS:

Arterial blood gases, end-tidal CO2. and esophageal pressure were recorded prior to and at the end of each period. Inspiratory muscle effort was assessed by measuring the esophageal pressure swing (∆PES) and the simplified esophageal pressure-time product (sPTPES). The other endpoints included physiologic dead space to tidal volume ratio (VD/VT) and the transpulmonary pressure swing. The APP increased the Pao2/Fio2 from 84 Torr (61-137 Torr) to 208 Torr (114-226 Torr) (p = 0.0007) and decreased both the VD/VT and the respiratory rate from 0.54 (0.47-0.57) to 0.49 (0.45-0.53) (p = 0.012) and from 26 breaths/min (21-30 breaths/min) to 21 breaths/min (19-22 breaths/min), respectively (p = 0.002). These variables remained unchanged during the SRP. The ∆PES and sPTPES per breath were unaffected by the position. However, the APP reduced the sPTPES per minute from 225 cm H2O.s.m-1 (176-332 cm H2O.s.m-1) to 174 cm H2O.s.m-1 (161-254 cm H2O.s.m-1) (p = 0.049).

CONCLUSIONS:

In spontaneously breathing patients with COVID-19-associated AHRF supported by high-flow nasal oxygen, the APP improves oxygenation and reduces the physiologic dead space, respiratory rate, and work of breathing per minute.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Crit Care Explor Year: 2022 Document Type: Article Affiliation country: CCE.0000000000000805

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Crit Care Explor Year: 2022 Document Type: Article Affiliation country: CCE.0000000000000805