scholarly journals Efficiency of Prolonged Prone Positioning for Mechanically Ventilated Patients Infected with COVID-19

2021 ◽  
Vol 10 (13) ◽  
pp. 2969
Author(s):  
Elizabeth M. Parker ◽  
Edward A. Bittner ◽  
Lorenzo Berra ◽  
Richard M. Pino
Keyword(s):  
Distress Syndrome ◽  
Tissue Injury ◽  
Blood Gases ◽  
Tracheal Extubation ◽  
Prone Positioning ◽  
Mechanically Ventilated ◽  
Single Turn ◽  
Baseline Values ◽  
Ventilator Settings ◽  
Ventilated Patients

Hypoxemia of the acute respiratory distress syndrome can be reduced by turning patients prone. Prone positioning (PP) is labor intensive, risks unplanned tracheal extubation, and can result in facial tissue injury. We retrospectively examined prolonged, repeated, and early versus later PP for 20 patients with COVID-19 respiratory failure. Blood gases and ventilator settings were collected before PP, at 1, 7, 12, 24, 32, and 39 h after PP, and 7 h after completion of PP. Analysis of variance was used for comparisons with baseline values at supine positions before turning prone. PP for >39 h maintained PaO2/FiO2 (P/F) ratios when turned supine; the P/F decrease at 7 h was not significant from the initial values when turned supine. Patients turned prone a second time, when again turned supine at 7 h, had significant decreased P/F. When PP started for an initial P/F ≤ 150 versus P/F > 150, the P/F increased throughout the PP and upon return to supine. Our results show that a single turn prone for >39 h is efficacious and saves the burden of multiple prone turns, and there is no significant advantage to initiating PP when P/F > 150 compared to P/F ≤ 150.

scholarly journals Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome due to COVID-19: A Cohort Study and Analysis of Physiology

2020 ◽  
Author(s):  
Mehdi Shelhamer ◽  
Paul D. Wesson ◽  
Ian L. Solari ◽  
Deanna L. Jensen ◽  
William Alex Steele ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Competing Risks ◽  
Distress Syndrome ◽  
Saturation Index ◽  
Hospital Death ◽  
Prone Positioning ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Physiologic Parameters ◽  
Ventilated Patients

Abstract BACKGROUND: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS) but it is unknown whether prone positioning improves outcomes in mechanically ventilated patients with moderate to severe ARDS due to COVID-19.METHODS: A cohort study at a New York City hospital at the peak of the early pandemic in the United States, under crisis conditions. The aim was to determine the benefit of prone positioning in mechanically ventilated patients with ARDS due to COVID-19. The primary outcome was in-hospital death. Secondary outcomes included changes in physiologic parameters. Fine-Gray competing risks models with stabilized inverse probability treatment weighting (sIPTW) were used to determine the effect of prone positioning on outcomes. In addition, linear mixed effects models (LMM) were used to assess changes in physiology with prone positioning.RESULTS: Out of 335 participants who were intubated and mechanically ventilated, 62 underwent prone positioning, 199 met prone positioning criteria and served as controls and 74 were excluded. The intervention and control groups were similar at baseline. In multivariate-adjusted competing risks models with sIPTW, prone positioning was significantly associated with reduced mortality (SHR 0.61, 95% CI 0.46-0.80, P < 0.005). Using LMM to evaluate the impact of positioning maneuvers on physiological parameters, the oxygenation-saturation index was significantly improved during days 1-3 (P < 0.01) whereas oxygenation-saturation index (OSI), oxygenation-index (OI) and arterial oxygen partial pressure to fractional inspired oxygen (PaO2:FiO2) were significantly improved during days 4-7 (P < 0.05 for all). CONCLUSIONS: Prone positioning in patients with moderate to severe ARDS due to COVID-19 is associated with reduced mortality and improved physiologic parameters. One in-hospital death could be averted for every eight patients treated. Replicating results and scaling the intervention are important, but prone positioning may represented an additional therapeutic option in patients with ARDS due to COVID-19.

scholarly journals Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome Due to COVID-19: A Cohort Study and Analysis of Physiology

2020 ◽  
Vol 36 (2) ◽  
pp. 241-252
Author(s):  
Mehdi C. Shelhamer ◽  
Paul D. Wesson ◽  
Ian L. Solari ◽  
Deanna L. Jensen ◽  
William Alex Steele ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Competing Risks ◽  
Distress Syndrome ◽  
Saturation Index ◽  
Hospital Death ◽  
Prone Positioning ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Physiologic Parameters ◽  
Ventilated Patients

Background: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS) but it is unknown whether prone positioning improves outcomes in mechanically ventilated patients with moderate to severe ARDS due to COVID-19. Methods: A cohort study at a New York City hospital at the peak of the early pandemic in the United States, under crisis conditions. The aim was to determine the benefit of prone positioning in mechanically ventilated patients with ARDS due to COVID-19. The primary outcome was in-hospital death. Secondary outcomes included changes in physiologic parameters. Fine-Gray competing risks models with stabilized inverse probability treatment weighting (sIPTW) were used to determine the effect of prone positioning on outcomes. In addition, linear mixed effects models (LMM) were used to assess changes in physiology with prone positioning. Results: Out of 335 participants who were intubated and mechanically ventilated, 62 underwent prone positioning, 199 met prone positioning criteria and served as controls and 74 were excluded. The intervention and control groups were similar at baseline. In multivariate-adjusted competing risks models with sIPTW, prone positioning was significantly associated with reduced mortality (SHR 0.61, 95% CI 0.46-0.80, P < 0.005). Using LMM to evaluate the impact of positioning maneuvers on physiological parameters, the oxygenation-saturation index was significantly improved during days 1-3 ( P < 0.01) whereas oxygenation-saturation index (OSI), oxygenation-index (OI) and arterial oxygen partial pressure to fractional inspired oxygen (PaO2: FiO2) were significantly improved during days 4-7 (P < 0.05 for all). Conclusions: Prone positioning in patients with moderate to severe ARDS due to COVID-19 is associated with reduced mortality and improved physiologic parameters. One in-hospital death could be averted for every 8 patients treated. Replicating results and scaling the intervention are important, but prone positioning may represent an additional therapeutic option in patients with ARDS due to COVID-19.

scholarly journals Assessment of Non-linear Imputation of PaO2/FiO2 from SpO2/FiO2 Among Patients Receiving Mechanical Ventilation in China

2021 ◽  
Author(s):  
Shan Wang ◽  
Liga Yusvirazi ◽  
Haiyan Yin ◽  
Hongjun Kang ◽  
Yan Zhao ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Arterial Blood Gas ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Arterial Blood ◽  
Non Linear ◽  
Log Linear ◽  
Ventilated Patients

Abstract Objectives: Arterial blood gas measurements are not always immediately available despite their potential relevance to management of mechanically ventilated patients. Retrospective and prospective studies have validated the non-linear imputation of PaO2/FIO2 from SpO2/FIO2, predominantly in USA. In this study, the objective was to validate the non-linear imputation algorithm among mechanically ventilated patients in the Chinese population. Method: Mechanically ventilated patients admitted to the emergency departments or ICUs at two participating hospitals in China were enrolled prospectively. At the time of a clinical arterial blood gas being drawn, SpO2, oximeter waveform characteristics, receipt of vasopressor, and skin pigmentation were simultaneously recorded. For the various imputation methods, we calculated both imputation error and the area under the curve for patients meeting criteria for acute respiratory distress syndrome (PaO2/FIO2 ≤ 300) and moderate-severe acute respiratory distress syndrome (PaO2/FIO2 ≤ 150). Result: We studied 663 arterial blood gases from 646 patients; 177 (26%) arterial blood gases were associated with SpO2 less than or equal to 96%. Non-linear imputation had lower mean absolute error than linear imputation method when SpO2 was less than or equal to 96% (p<0.001). At the PaO2/FiO2 threshold of 300 or less, non-linear imputation AUC (0.90 95% CI 0.85-0/95) was not significantly higher than the AUCs of linear and log-linear imputation methods (0.88 95% CI 0.82-0.94). The same result was shown at the PaO2 /FiO2 threshold of 150 or less. For patients with a threshold SpO2 of 96% or less, AUC analysis yielded similar results between non-linear vs. linear and log-linear imputations. Conclusions: In this cohort of mechanically ventilated patients, non-linear imputation was not superior to linear and log-linear imputations for patients with SpO2 of 96% or less. All strategies performed similarly in estimating PaO2/FIO2 from SpO2/FIO2.

Auto-PEEP effects on respiratory mechanics and blood gases in mechanically ventilated patients

1998 ◽  
Vol 74 (4) ◽  
pp. 275-83
Author(s):  
Antônio C. P. Ferreira ◽  
Benjamin I. Kopelman ◽  
Werther Brunow de Carvalho ◽  
Jorge Bonassa
Keyword(s):  
Respiratory Mechanics ◽  
Blood Gases ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients
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