scholarly journals Effect of awake prone position on diaphragmatic thickening fraction in patients assisted by noninvasive ventilation for hypoxemic acute respiratory failure related to novel coronavirus disease

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Gianmaria Cammarota ◽  
Elisa Rossi ◽  
Leonardo Vitali ◽  
Rachele Simonte ◽  
Tiziano Sannipoli ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Prone Position ◽  
Noninvasive Ventilation ◽  
Supine Position ◽  
Rating Scale ◽  
Rescue Therapy ◽  
Comfort Level ◽  
Entire Study ◽  
Hypoxemic Acute Respiratory Failure ◽  
Novel Coronavirus

Abstract Background Awake prone position is an emerging rescue therapy applied in patients undergoing noninvasive ventilation (NIV) for acute hypoxemic respiratory failure (ARF) related to novel coronavirus disease (COVID-19). Although applied to stabilize respiratory status, in awake patients, the application of prone position may reduce comfort with a consequent increase in the workload imposed on respiratory muscles. Thus, we primarily ascertained the effect of awake prone position on diaphragmatic thickening fraction, assessed through ultrasound, in COVID-19 patients undergoing NIV. Methods We enrolled all COVID-19 adult critically ill patients, admitted to intensive care unit (ICU) for hypoxemic ARF and undergoing NIV, deserving of awake prone positioning as a rescue therapy. Exclusion criteria were pregnancy and any contraindication to awake prone position and NIV. On ICU admission, after NIV onset, in supine position, and at 1 h following awake prone position application, diaphragmatic thickening fraction was obtained on the right side. Across all the study phases, NIV was maintained with the same setting present at study entry. Vital signs were monitored throughout the entire study period. Comfort was assessed through numerical rating scale (0 the worst comfort and 10 the highest comfort level). Data were presented in median and 25th–75th percentile range. Results From February to May 2021, 20 patients were enrolled and finally analyzed. Despite peripheral oxygen saturation improvement [96 (94–97)% supine vs 98 (96–99)% prone, p = 0.008], turning to prone position induced a worsening in comfort score from 7.0 (6.0–8.0) to 6.0 (5.0–7.0) (p = 0.012) and an increase in diaphragmatic thickening fraction from 33.3 (25.7–40.5)% to 41.5 (29.8–50.0)% (p = 0.025). Conclusions In our COVID-19 patients assisted by NIV in ICU, the application of awake prone position improved the oxygenation at the expense of a greater diaphragmatic thickening fraction compared to supine position. Trial registration ClinicalTrials.gov, number NCT04904731. Registered on 05/25/2021, retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04904731.

scholarly journals Impact of HACOR Score on Noninvasive Ventilation Failure in Non-COPD Patients with Acute-on-Chronic Respiratory Failure

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Min Ding ◽  
Xiaoli Han ◽  
Linfu Bai ◽  
Shicong Huang ◽  
Jun Duan
Keyword(s):  
Respiratory Failure ◽  
Sensitivity And Specificity ◽  
Noninvasive Ventilation ◽  
Rating Scale ◽  
Characteristic Curve ◽  
Respiratory Acidosis ◽  
Chronic Respiratory Failure ◽  
Chronic Obstructive ◽  
Hospital Data ◽  
Copd Patients

Background. A rating scale that takes into account heart rate, acidosis, consciousness, oxygenation, and respiratory rate (the HACOR score) has been used to predict noninvasive ventilation (NIV) failure in patients with chronic obstructive pulmonary disease (COPD). However, the HACOR score has not been used to predict NIV failure in non-COPD patients with acute-on-chronic respiratory failure. Methods. This study was performed in the respiratory intensive care unit of a teaching hospital. Data had been collected prospectively between June 2011 and January 2019. We enrolled non-COPD patients who received NIV due to acute-on-chronic respiratory failure, pH < 7.35, and PaCO2 >45 mmHg. NIV failure was defined as requiring intubation or dying during NIV. The HACOR score was determined at initiation and after 1-2, 12, and 24 h of NIV. Scores can range from 0 to 27, with higher scores indicating a higher risk of NIV failure. Results. A total of 148 patients were enrolled in the study, 52 with sleep apnea-hypopnea syndrome, 34 with chronic thoracic sequelae, 31 with bronchiectasis, 14 with chest wall deformity, 5 with obesity-hypoventilation syndrome, and 12 with other conditions. Of the patients, 19 (13%) experienced NIV failure. From initiation to 24 h of NIV, the HACOR scores of patients who experienced NIV failure were much higher than those of patients who received successful NIV. The area under the receiver operating characteristic curve was 0.69, 0.91, 0.91, and 0.94 when the HACOR score was tested at initiation and after 1-2, 12, and 24 h of NIV, respectively. To obtain the best sensitivity and specificity, the cutoff value at initiation was 7 with a sensitivity of 68% and a specificity of 61%. After 1-2 h of NIV, it was 5 with a sensitivity of 90% and a specificity of 85%. After 12 h of NIV, it was 4 with a sensitivity of 82% and a specificity of 91%. After 24 h of NIV, it was 2 with a sensitivity of 100% and a specificity of 76%. Conclusions. The HACOR score has high sensitivity and specificity for predicting NIV failure among non-COPD patients who receive NIV due to acute-on-chronic respiratory failure with respiratory acidosis.

Does gas exchange response to prone position predict mortality in hypoxemic acute respiratory failure?

2006 ◽  
Vol 32 (12) ◽  
pp. 1987-1993 ◽  
Author(s):  
Stéphane Lemasson ◽  
Louis Ayzac ◽  
Raphaelle Girard ◽  
Sandrine Gaillard ◽  
Karine Pavaday ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Gas Exchange ◽  
Acute Respiratory Failure ◽  
Prone Position ◽  
Hypoxemic Acute Respiratory Failure

Noninvasive Ventilation for Patients with Hypoxemic Acute Respiratory Failure

2014 ◽  
Vol 35 (04) ◽  
pp. 492-500 ◽  
Author(s):  
Jean-Claude Lefebvre ◽  
Ricardo Cordioli ◽  
Evangelia Akoumianaki ◽  
Jean-Christophe Richard ◽  
Laurent Brochard
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Hypoxemic Acute Respiratory Failure

scholarly journals Prolonged Active Prone Positioning in Spontaneously Breathing Non-intubated Patients With COVID-19-Associated Hypoxemic Acute Respiratory Failure With PaO2/FiO2 >150

2021 ◽  
Vol 8 ◽  
Author(s):  
Paola Pierucci ◽  
Nicolino Ambrosino ◽  
Valentina Di Lecce ◽  
Michela Dimitri ◽  
Stefano Battaglia ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Prone Position ◽  
Hospital Length Of Stay ◽  
Respiratory Support ◽  
Control Group ◽  
Prone Positioning ◽  
Non Invasive ◽  
Hypoxemic Acute Respiratory Failure ◽  
Spontaneously Breathing

Background: The COVID-19 pandemic has led to new approaches to manage patients outside the ICU, including prone positioning in non-intubated patients.Objectives: To report the use of prolonged active prone positioning in spontaneously breathing patients with COVID-19-associated acute respiratory failure. Spontaneously breathing vs non-invasive respiratory support for COVID19 associated acute respiratory failure.Methods: Patients with PaO2/FiO2 &gt; 150, with lung posterior consolidations as assessed by means of lung ultrasound, and chest x-ray were studied. Under continuous pulse oximetry (SpO2) monitoring, patients maintained active prone position. A PaO2/FiO2 &lt; 150 was considered as treatment failure and patients had to be switched to non-invasive respiratory support. Retrospectively, data of 16 patients undergoing who refused proning and underwent non-invasive respiratory support were used as controls. The primary outcome was the proportion of patients maintaining prolonged prone position and discharged home. Secondary outcomes included improvement in oxygenation, hospital length of stay, and 6-month survival.Results: Three out of 16 (18.7%) patients did not tolerate the procedure. Three more patients showed a worsening in PaO2/FiO2 to &lt;150 and required non-invasive support, two of whom finally needing endotracheal intubation. After 72 h, 10 out of 16 (62.5%) patients improved oxygenation [PaO2/FiO2: from 194.6 (42.1) to 304.7 (79.3.2) (p &lt; 0.001)] and were discharged home. In the control group, three out of 16 failed, required invasive ventilatory support, and died within 1 month in ICU. Thirteen were successful and discharged home.Conclusion: In non-intubated spontaneously breathing COVID-19 patients with PaO2/FiO2 &gt;150, active prolonged prone positioning was feasible and tolerated with significant improvement in oxygenation.

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