Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology study
Background: Awake prone positioning (APP) can reportedly reduce the need for intubation and help improve prognosis of patients with acute hypoxemic respiratory failure (AHRF) infected with COVID-19. However, its physiological mechanism remains unclear. In this study, we evaluated the effect of APP o...
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Elsevier
2025-01-01
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| Series: | Journal of Intensive Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667100X24000987 |
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| author | Jingjing Wang Changxing Chen Zhanqi Zhao Puyu Deng Chenchen Zhang Yu Zhang Hui Lv Daonan Chen Hui Xie Ruilan Wang |
| author_facet | Jingjing Wang Changxing Chen Zhanqi Zhao Puyu Deng Chenchen Zhang Yu Zhang Hui Lv Daonan Chen Hui Xie Ruilan Wang |
| author_sort | Jingjing Wang |
| collection | DOAJ |
| description | Background: Awake prone positioning (APP) can reportedly reduce the need for intubation and help improve prognosis of patients with acute hypoxemic respiratory failure (AHRF) infected with COVID-19. However, its physiological mechanism remains unclear. In this study, we evaluated the effect of APP on lung ventilation in patients with moderate-to-severe AHRF to better understand the effects on ventilation distribution and to prevent intubation in non-intubated patients. Methods: The prospective study was performed in the Department of Critical Care Medicine at Shanghai General Hospital, China, from January 2021 to November 2022. The study included patients with AHRF (partial pressure of oxygen [PaO2]/inspired oxygen concentration [FiO2] <200 mmHg or oxygen saturation [SpO2]/FiO2 <235) treated with high-flow nasal oxygen. Electrical impedance tomography (EIT) measurements including center of ventilation (COV), global inhomogeneity (GI) index, and regional ventilation delay (RVD) index were performed in the supine position (T0), 30 min after the start of APP (T1), and 30 min returning to supine position after the APP (T2). Clinical parameters like SpO2, respiratory rate (RR), FiO2, heart rate (HR), and ROX (the ratio of SpO2 as measured by pulse oximetry/FiO2 to RR) were also recorded simultaneously at T0, T1, and T2. To evaluate the effect of the time points on the variables, Mauchly's test was performed for sphericity and repeated measures analysis of variance was applied with Bonferroni's post hoc multiple comparisons. Results: Ten patients were enrolled. The PaO2/FiO2 ratio was (111.4±33.4) mmHg at the time of recruitment. ROX showed a significant increase after initiation of APP {median (interquartile range [IQR]): T0: 7.5 (6.0–10.1) vs. T1: 7.6 (6.4–9.3) vs. T2: 8.3 (7.2–11.0), P=0.043}. RR (P=0.409), HR (P=0.417), and SpO2/FiO2 (P=0.262) did not change significantly during prone positioning (PP). The COV moved from the ventral area to the dorsal area (T0: 48.8%±6.2% vs. T1: 54.8%±6.8% vs. T2: 50.3%±6.1%, P=0.030) after APP. The GI decreased significantly after APP (T0: median=42.7 %, [IQR: 38.3%–47.5%] vs. T1: median=38.2%, [IQR: 34.6%–50.7%] vs. T2: median=37.4%, [IQR: 34.2%–41.4%], P=0.049). RVD (P=0.794) did not change after APP. Conclusions: APP can improve ventilation distribution and homogeneity of lung ventilation as assessed by EIT in non-intubated patients with AHRF.Trail Registration Chinese Clinical Trial Registry Identifier: ChiCTR2000035895. |
| format | Article |
| id | doaj-art-3cf8462b832e4b8c903dec001afd6a4b |
| institution | Kabale University |
| issn | 2667-100X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Intensive Medicine |
| spelling | doaj-art-3cf8462b832e4b8c903dec001afd6a4b2025-01-05T04:28:48ZengElsevierJournal of Intensive Medicine2667-100X2025-01-01514350Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology studyJingjing Wang0Changxing Chen1Zhanqi Zhao2Puyu Deng3Chenchen Zhang4Yu Zhang5Hui Lv6Daonan Chen7Hui Xie8Ruilan Wang9Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaCritical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, GermanyCritical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaCritical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaCritical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaCritical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaCritical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaCritical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaCritical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Corresponding author: Ruilan Wang, Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Wujin Road 85, Shanghai 20000, China.Background: Awake prone positioning (APP) can reportedly reduce the need for intubation and help improve prognosis of patients with acute hypoxemic respiratory failure (AHRF) infected with COVID-19. However, its physiological mechanism remains unclear. In this study, we evaluated the effect of APP on lung ventilation in patients with moderate-to-severe AHRF to better understand the effects on ventilation distribution and to prevent intubation in non-intubated patients. Methods: The prospective study was performed in the Department of Critical Care Medicine at Shanghai General Hospital, China, from January 2021 to November 2022. The study included patients with AHRF (partial pressure of oxygen [PaO2]/inspired oxygen concentration [FiO2] <200 mmHg or oxygen saturation [SpO2]/FiO2 <235) treated with high-flow nasal oxygen. Electrical impedance tomography (EIT) measurements including center of ventilation (COV), global inhomogeneity (GI) index, and regional ventilation delay (RVD) index were performed in the supine position (T0), 30 min after the start of APP (T1), and 30 min returning to supine position after the APP (T2). Clinical parameters like SpO2, respiratory rate (RR), FiO2, heart rate (HR), and ROX (the ratio of SpO2 as measured by pulse oximetry/FiO2 to RR) were also recorded simultaneously at T0, T1, and T2. To evaluate the effect of the time points on the variables, Mauchly's test was performed for sphericity and repeated measures analysis of variance was applied with Bonferroni's post hoc multiple comparisons. Results: Ten patients were enrolled. The PaO2/FiO2 ratio was (111.4±33.4) mmHg at the time of recruitment. ROX showed a significant increase after initiation of APP {median (interquartile range [IQR]): T0: 7.5 (6.0–10.1) vs. T1: 7.6 (6.4–9.3) vs. T2: 8.3 (7.2–11.0), P=0.043}. RR (P=0.409), HR (P=0.417), and SpO2/FiO2 (P=0.262) did not change significantly during prone positioning (PP). The COV moved from the ventral area to the dorsal area (T0: 48.8%±6.2% vs. T1: 54.8%±6.8% vs. T2: 50.3%±6.1%, P=0.030) after APP. The GI decreased significantly after APP (T0: median=42.7 %, [IQR: 38.3%–47.5%] vs. T1: median=38.2%, [IQR: 34.6%–50.7%] vs. T2: median=37.4%, [IQR: 34.2%–41.4%], P=0.049). RVD (P=0.794) did not change after APP. Conclusions: APP can improve ventilation distribution and homogeneity of lung ventilation as assessed by EIT in non-intubated patients with AHRF.Trail Registration Chinese Clinical Trial Registry Identifier: ChiCTR2000035895.http://www.sciencedirect.com/science/article/pii/S2667100X24000987Acute hypoxemic respiratory failureProne positionsElectrical impedance tomography |
| spellingShingle | Jingjing Wang Changxing Chen Zhanqi Zhao Puyu Deng Chenchen Zhang Yu Zhang Hui Lv Daonan Chen Hui Xie Ruilan Wang Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology study Journal of Intensive Medicine Acute hypoxemic respiratory failure Prone positions Electrical impedance tomography |
| title | Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology study |
| title_full | Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology study |
| title_fullStr | Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology study |
| title_full_unstemmed | Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology study |
| title_short | Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure: A prospective physiology study |
| title_sort | awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non covid 19 acute hypoxemic respiratory failure a prospective physiology study |
| topic | Acute hypoxemic respiratory failure Prone positions Electrical impedance tomography |
| url | http://www.sciencedirect.com/science/article/pii/S2667100X24000987 |
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