Impact of Prone Position on Dead-space Fraction in COVID-19 Related Acute Respiratory Distress Syndrome

Overview

Journal BMC Pulm Med

Publisher Biomed Central

Specialty Pulmonary Medicine

Date 2024 Jan 5

PMID 38183063

Authors

Guillaume Thery

Astree Scemama

Elvire Roblin

Morgan Caplan

Bruno Mourvillier

Antoine Goury

Affiliations

Soon will be listed here.

Abstract

Introduction: COVID-19 Related Acute Respiratory Syndrome (C-ARDS) is characterized by a mismatch between respiratory mechanics and hypoxemia, suggesting increased dead-space fraction (DSF). Prone position is a cornerstone treatment of ARDS under invasive mechanical ventilation reducing mortality. We sought to investigate the impact of prone position on DSF in C-ARDS in a cohort of patients receiving invasive mechanical ventilation.

Methods: we retrospectively analysed data from 85 invasively mechanically ventilated patients with C-ARDS in supine and in prone positions, hospitalized in Intensive Care Unit (Reims University Hospital), between November, 1st 2020 and November, 1st 2022. DSF was estimated via 3 formulas usable at patients' bedside, based on partial pressure of carbon dioxide (PaCO2) and end-tidal carbon dioxide (EtCO2).

Results: there was no difference of DSF between supine and prone position, using the 3 formulas. According to Enghoff, Frankenfield and Gattinoni equations, DSF in supine vs. prone position was in median respectively [IQR]: 0.29 [0.13-0.45] vs. 0.31 [0.19-0.51] (p = 0.37), 0.5 [0.48-0.52] vs. 0.51 [0.49-0.53] (p = 0.43), and 0.71 [0.55-0.87] vs. 0.69 [0.57-0.81], (p = 0.32).

Conclusion: prone position did not change DSF in C-ARDS.

References

Gattinoni L, Coppola S, Cressoni M, Busana M, Rossi S, Chiumello D . COVID-19 Does Not Lead to a "Typical" Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2020; 201(10):1299-1300. PMC: 7233352. DOI: 10.1164/rccm.202003-0817LE. View

Frankenfield D, Alam S, Bekteshi E, Vender R . Predicting dead space ventilation in critically ill patients using clinically available data. Crit Care Med. 2009; 38(1):288-91. DOI: 10.1097/CCM.0b013e3181b42e13. View

Gattinoni L, Chiumello D, Rossi S . COVID-19 pneumonia: ARDS or not?. Crit Care. 2020; 24(1):154. PMC: 7160817. DOI: 10.1186/s13054-020-02880-z. View

Dantzker D, Lynch J, Weg J . Depression of cardiac output is a mechanism of shunt reduction in the therapy of acute respiratory failure. Chest. 1980; 77(5):636-42. DOI: 10.1378/chest.77.5.636. View

Kallet R, Lipnick M . End-Tidal-to-Arterial P Ratio as Signifier for Physiologic Dead-Space Ratio and Oxygenation Dysfunction in Acute Respiratory Distress Syndrome. Respir Care. 2020; 66(2):263-268. DOI: 10.4187/respcare.08061. View

NUNN J, HOLMDAHL M . Henrik Enghoff and the volumen inefficax. Ups J Med Sci. 1979; 84(2):105-8. DOI: 10.3109/03009737909179145. View

Pan C, Chen L, Lu C, Zhang W, Xia J, Sklar M . Lung Recruitability in COVID-19-associated Acute Respiratory Distress Syndrome: A Single-Center Observational Study. Am J Respir Crit Care Med. 2020; 201(10):1294-1297. PMC: 7233342. DOI: 10.1164/rccm.202003-0527LE. View

RILEY R, COURNAND A . Ideal alveolar air and the analysis of ventilation-perfusion relationships in the lungs. J Appl Physiol. 1949; 1(12):825-47. DOI: 10.1152/jappl.1949.1.12.825. View

Fossali T, Pavlovsky B, Ottolina D, Colombo R, Basile M, Castelli A . Effects of Prone Position on Lung Recruitment and Ventilation-Perfusion Matching in Patients With COVID-19 Acute Respiratory Distress Syndrome: A Combined CT Scan/Electrical Impedance Tomography Study. Crit Care Med. 2022; 50(5):723-732. PMC: 9005091. DOI: 10.1097/CCM.0000000000005450. View

10.

Gattinoni L, Taccone P, Carlesso E, Marini J . Prone position in acute respiratory distress syndrome. Rationale, indications, and limits. Am J Respir Crit Care Med. 2013; 188(11):1286-93. DOI: 10.1164/rccm.201308-1532CI. View

11.

Sharp T, Al-Faham Z, Brown M, Martin-Lazaro J, Cevallos Morales J . Prone position in covid-19: Can we tackle rising dead space?. J Intensive Care Soc. 2022; 23(2):240-243. PMC: 9125443. DOI: 10.1177/1751143720975317. View

12.

van Meenen D, Roozeman J, Serpa Neto A, Pelosi P, de Abreu M, Horn J . Associations between changes in oxygenation, dead space and driving pressure induced by the first prone position session and mortality in patients with acute respiratory distress syndrome. J Thorac Dis. 2020; 11(12):5004-5013. PMC: 6987992. DOI: 10.21037/jtd.2019.12.38. View

13.

Zarantonello F, Sella N, Pettenuzzo T, Andreatta G, Calore A, Dotto D . Early Physiologic Effects of Prone Positioning in COVID-19 Acute Respiratory Distress Syndrome. Anesthesiology. 2022; 137(3):327-339. DOI: 10.1097/ALN.0000000000004296. View

14.

Vasques F, Sanderson B, Formenti F, Shankar-Hari M, Camporota L . Physiological dead space ventilation, disease severity and outcome in ventilated patients with hypoxaemic respiratory failure due to coronavirus disease 2019. Intensive Care Med. 2020; 46(11):2092-2093. PMC: 7393807. DOI: 10.1007/s00134-020-06197-x. View