Improved Oxygenation in Prone Positioning of Mechanically Ventilated Patients with COVID-19 Acute Respiratory Distress Syndrome is Associated with Decreased Pulmonary Shunt Fraction: a Prospective Multicenter Study

Overview

Journal Eur J Med Res

Publisher Biomed Central

Specialty General Medicine

Date 2023 Dec 16

PMID 38102699

Authors

Piotr Harbut

Francesca Campoccia Jalde

Martin Dahlberg

Anders Forsgren

Elisabeth Andersson

Andreas Lundholm

Jaroslaw Janc

Patrycja Lesnik

Michal Suchanski

Pawel Zatorski

Janusz Trzebicki

Tomasz Skalec

Mattias Gunther

Affiliations

Soon will be listed here.

Abstract

Background: Prone position is used in acute respiratory distress syndrome and in coronavirus disease 2019 (Covid-19) acute respiratory distress syndrome (ARDS). However, physiological mechanisms remain unclear. The aim of this study was to determine whether improved oxygenation was related to pulmonary shunt fraction (Q's/Q't), alveolar dead space (Vd/Vtalv) and ventilation/perfusion mismatch (V'/Q').

Methods: This was an international, prospective, observational, multicenter, cohort study, including six intensive care units in Sweden and Poland and 71 mechanically ventilated adult patients.

Results: Prone position increased PaO:FiO after 30 min, by 78% (83-148 mm Hg). The effect persisted 120 min after return to supine (p < 0.001). The oxygenation index decreased 30 min after prone positioning by 43% (21-12 units). Q's/Q't decreased already after 30 min in the prone position by 17% (0.41-0.34). The effect persisted 120 min after return to supine (p < 0.005). Q's/Q't and PaO:FiO were correlated both in prone (Beta -137) (p < 0.001) and in the supine position (Beta -270) (p < 0.001). V'/Q' was unaffected and did not correlate to PaO:FiO (p = 0.8). Vd/Vtalv increased at 120 min by 11% (0.55-0.61) (p < 0.05) and did not correlate to PaO:FiO (p = 0.3). The ventilatory ratio increased after 30 min in the prone position by 58% (1.9-3.0) (p < 0.001). PaO:FiO at baseline predicted PaO:FiO at 30 min after proning (Beta 1.3) (p < 0.001).

Conclusions: Improved oxygenation by prone positioning in COVID-19 ARDS patients was primarily associated with a decrease in pulmonary shunt fraction. Dead space remained high and the global V'/Q' measure could not explain the differences in gas exchange.

Citing Articles

Prone positioning.

Guerin C, Li J, Grasselli G Intensive Care Med. 2024; 50(6):968-970.

PMID: 38656358 DOI: 10.1007/s00134-024-07413-8.

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