Clinical study of lateral position ventilation in severe coronavirus disease 2019 patients

doi:10.3877/cma.j.issn.2096-1537.2021.01.004

Abstract

Abstract:

Objective

To investigate clinical effects of lateral position ventilation in the patients with severe coronavirus disease 2019 (COVID-19).

Methods

Retrospectively collecting data of 41 COVID-19 patients with moderate and severe acute respiratory distress syndrome (ARDS) hospitalized in the critical emergency ward of Chongqing Three Gorges Central Hospital from January 20 to March 7, 2020. The patients treated with high-flow nasal canula therapy (HFNC) or noninvasive ventilation (NIV) were divided into two groups: lateral position group (n=24) and supine position group (n=17). The gender, age, acute physiology and chronic health evaluation (APACHE) Ⅱ score,comorbidities of the two groups were compared. Respiratory rate (RR), oxygenation index (PaO₂/FiO₂), partial pressure of carbon dioxide (PaCO₂) and mean arterial pressure (MAP) of the two groups were compared before and on the first, third and fifth day of treatment. The amelioration rate, duration of HFNC or NPPV, incidence of tracheal intubation, length of stay in hospital and occurrence of bedsore of the two groups were compared too.

Results

Among 41 patients, 21 were male and 20 were female, with an average age of (60.9±11.1) years (43-79 years). There was no significant difference in age, gender, APACHE Ⅱ score, comorbidities, RR, PaO₂/FiO₂, PaCO₂and MAP before treatment between the two groups (P all＞0.05). HR, RR and MAP decreased after treatment in both groups,while PCO₂ and PaO₂/FiO₂ increased. PaO₂/FiO₂ improved significantly on the 5th day in both groups [(166.4±45.4) mmHg vs (253.0±66.0) mmHg in lateral position ventilation group and (183.8±54.4) mmHg vs (227.4±62.8) mmHg in supine position ventilation group, P all＜0.05, 1 mmHg=0.133 kPa]. Compared with supine position ventilation group, RR was lower in the lateral position ventilation group on the first day after treatment (P=0.006); PaO₂/FiO₂ increased significantly in moderate and severe ARDS patients in lateral position group on the 5th day after treatment [(221.6±64.9) vs (260.8±58.5) mmHg, P=0.043],compared with supine position ventilation. There was no significant difference in duration of HFNC or NIV and the incidence of endotracheal intubation between the two groups (P all＞0.05). Compared with the supine position ventilation group, the length of stay in hospital and in ICU was significantly shorter in the lateral position ventilation group [(15.5±7.2) d vs (21.5±9.8) d, P=0.028; (10.3±6.3) d vs (16.9±11.0) d, P=0.021], and the mortality was also lower in lateral position ventilation group (8.3% vs 23.5%, P=0.047).

Conclusion

Lateral position ventilation can improve oxygenation, reduce length of stay in hospital and ICU, mortality in COVID-19 patients with moderate and severe ARDS.

Key words: Lateral position ventilation, Coronavirus disease 2019, Acute respiratory distress syndrome

Qilong Zhou, Pengfei Pan, Hua Lu, Xi Yue, Jianxing Zhao, Jianguo Chen, Chao Liu, Fang Xiong, Xia Huang, Xiangyou Yu. Clinical study of lateral position ventilation in severe coronavirus disease 2019 patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(01): 21-27.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2021.01.004

https://icu.cma-cmc.com.cn/EN/Y2021/V07/I01/21

Figures/Tables 5

一般情况	侧卧位组（24例）	仰卧位组（17例）	统计值	P值
年龄（岁， $x ¯$ ±s）	59.5±10.8	62.8±11.4	t=0.921	0.343
性别（男/女）	12/12	9/8	χ²=0.034	0.853
APACHEⅡ评分（分， $x ¯$ ±s）	6.96±2.82	7.06±3.49	t=0.010	0.919
合并症			χ²=0.539	0.910
糖尿病	5	5
高血压	2	1
慢性阻塞性肺疾病	1	1
无创呼吸支持方式			χ²=0.121	0.941
HFNC	10	7
NPPV	6	5
HFNC联合NPPV	8	5

一般情况	侧卧位组（24例）	仰卧位组（17例）	统计值	P值
年龄（岁， $x ¯$ ±s）	59.5±10.8	62.8±11.4	t=0.921	0.343
性别（男/女）	12/12	9/8	χ²=0.034	0.853
APACHEⅡ评分（分， $x ¯$ ±s）	6.96±2.82	7.06±3.49	t=0.010	0.919
合并症			χ²=0.539	0.910
糖尿病	5	5
高血压	2	1
慢性阻塞性肺疾病	1	1
无创呼吸支持方式			χ²=0.121	0.941
HFNC	10	7
NPPV	6	5
HFNC联合NPPV	8	5

参数	侧卧位组（24例）	仰卧位组（17例）	t值	P值
HR（次/min）
治疗前	95.8±12.1	97.35±12.17	0.156	0.695
治疗后第1天	87.7±9.4	87.47±10.03	0.004	0.949
治疗后第3天	82.5±7.9^a	87.53±11.95	2.673	0.110
治疗后第5天	83.8±13.2^a	86.12±13.53^a	0.859	0.360
RR（次/min）
治疗前	28.3±6.9	29.6±5.7	0.429	0.516
治疗后第1天	23.4±2.2^a	25.7±2.6^a	8.630	0.006
治疗后第3天	22.8±1.6^a	23.0±2.2^a	0.080	0.779
治疗后第5天	22.6±2.3^a	24.1±3.5^a	2.951	0.094
MAP（mmHg）
治疗前	77.1±6.9	78.0±8.2	0.138	0.713
治疗后第1天	74.0±4.9	75.4±4.5	0.804	0.375
治疗后第3天	70.4±5.2^a	70.9±4.8^a	0.108	0.744
治疗后第5天	72.5±5.8^a	73.0±4.9^a	0.084	0.773
PaCO₂（mmHg）
治疗前	35.5±6.9	35.9±8.7	0.020	0.889
治疗后第1天	32.3±4.8^a	34.5±7.7	0.1371	0.249
治疗后第3天	34.8±5.0	35.8±7.8	0.217	0.644
治疗后第5天	38.5±5.9	39.4±8.3	0.149	0.702
PaO₂/FiO₂（mmHg）
治疗前	166.4±45.4	183.8±54.4	1.233	0.274
治疗后第1天	161.3±32.1	177.8±48.4	1.715	0.198
治疗后第3天	189.5±48.8	179.8±38.2	0.475	0.495
治疗后第5天	253.0±66.0^a	227.4±62.8^a	1.551	0.220

参数	侧卧位组（24例）	仰卧位组（17例）	t值	P值
RR（次/min）
治疗前	28.5±6.4	28.1±5.2	0.031	0.861
治疗后第1天	23.5±2.4	24.6±1.8	2.100	0.156
治疗后第3天	22.8±1.3	22.4±2.0	0.414	0.525
治疗后第5天	22.3±2.2	23.4±4.0	2.163	0.151
PaO₂/FiO₂（mmHg）
治疗前	152.2±32.7	160.8±36.9	0.504	0.483
治疗后第1天	164.0±31.6	167.7±22.2	0.134	0.717
治疗后第3天	197.8±43.7	189.8±37.1	0.289	0.595
治疗后第5天	260.8±58.5	221.6±64.9	3.843	0.043

组别	例数	病死情况[例（%）]	无创呼吸支持时间（d）	气管插管情况[例（%）]	ICU住院时间（d）	总住院时间（d）
侧卧位组	24	2（8.3）	5.0±2.0	4(24，16.67)	10.3±6.3	15.5±7.2
仰卧位组	17	4（23.5）	6.5±4.9	4(17，23.53)	16.9±11.0	21.5±9.8
统计值		χ²=3.576	t=1.823	χ²=0.298	t=5.830	t=5.183
P值		0.047	0.185	0.585	0.021	0.028

References 27

1	Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [J]. Lancet, 2020, 395(10223): 497-506.
2	International Committee on Taxonomy of Viruses. The virus causing the current outbreak of coronavirus disease has been named "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2)[EB/OL]. (2020-02-13)[2020-02-12]. URL
3	国家卫生健康委. 新型冠状病毒感染的肺炎诊疗方案(试行第七版) [EB/OL]. (2020-3-4). URL
4	Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition [J]. JAMA, 2012, 307(23): 2526-2533.
5	Zhu N, Zhang DY, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019 [J]. N Engl J Med, 2020, 382(8): 727-733.
6	Zhou P, Yang XL, Wang XG, et al.A pneumonia outbreak associated with a new coronavirus of probable bat origin [J].Nature,2020, 579(7798): 270-273 .
7	World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV)[EB/OL]. URL
8	World Health Organization. Consensus document on the epidemiology of severe acute respiratory syndrome (SARS)[EB/OL]. URL
9	Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in china: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention [J]. JAMA, 2020, 323(13): 1239-1242.
10	Zhou F, Yu T, Du RH, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [J] Lancet, 2020, 395: 1054-1062.
11	Lei J, Li J, Li X, et al. CT Imaging of the 2019 novel coronavirus (2019-nCoV) pneumonia [J]. Radiology, 2020, 295(1): 18.
12	Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID- 19 associated with acute respiratory distress syndrome [J]. Lancet Respir Med, 2020, 8(4): 420-422.
13	刘茜, 王荣帅, 屈国强, 等. 新型冠状病毒肺炎死亡尸体系统解剖大体观察报告[J].法医学杂志, 2020, 36(1): 21-23.
14	Tian S, Hu W, Niu L, et al. Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer [J]. J Thorac Oncol, 2020, 15(5): 700-704.
15	Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States [J]. N Engl J Med, 2020, 382(10): 929-936.
16	Lin S, Shen RN, Guo XS. Molecular modeling evaluation of the binding abilities of ritonavir and lopinavir to Wuhan pneumonia coronavirus proteases [J]. bioRxiv preprint, 2020.01.31.
17	Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro [J]. Cell Res, 2020, 30(3): 269-271.
18	Chen L, Xia HF, Shang Y, et al. Molecular mechanisms of ventilator-induced lung injury [J]. Chin Med J, 2018, 131(10): 1225-1231.
19	Fan E, Brodie D, Slutsky AS. Acute respiratory distress syndrome: advances in diagnosis and treatment [J]. JAMA, 2018, 319(7): 698-710.
20	Lee JM, Bae W, Lee YJ, et al. The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials [J]. Crit Care Med, 2014, 42(5): 1252-1262.
21	Staudinger T, Kofler J, Müllner M, et al.Comparison of prone positioning and continuous rotation of patients with adult respiratory distress syndrome: results of a pilot study [J]. Crit Care Med, 2001, 29(1): 51-56.
22	Kim MJ, Hwang HJ, Song HH. A randomized trial on the effects of body positions on lung function with acute respiratory failure patients [J]. Int J Nurs Stud, 2002, 39(5): 549-555.
23	Chechenin MG, Voevodin SV, EIu P, et al. Kinetic therapy for acute respiratory distress syndrome [J]. Anesteziol Reanimatol, 2004, 370(6): 8-12.
24	于湘友, 杨春波, 王毅. 侧卧位通气治疗肺内/肺外源性急性呼吸窘迫综合征的对比观察[J].中华急诊医学杂志, 2012, 21(3): 249-251.
25	Wieslander B, Ramos JG, Ax M, et al. Supine, prone, right and left gravitational effects on human pulmonary circulation [J]. J Cardiovasc Magn Reson, 2019, 21(1): 69.
26	钱民, 李建国. 侧卧位通气对急性呼吸窘迫综合征患者影响的研究 [J]. 现代中西医结合杂志, 2015, 14(11): 1158-1160, 1164.
27	Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China [J]. JAMA, 2020, 323(11): 1061-1069.

[1]	Lung Transplantation Study Group, Branch of Organ Transplantation of Chinese Medical Association;, National Lung Transplantation Quality Control Center. Selection of lung transplant candidates with COVID-19: Advises from China lung transplant expert group [J]. Chinese Journal of Transplantation(Electronic Edition), 2023, 17(01): 13-16.
[2]	Ting Luo, Shi Zhang. Prognostic analysis of 5 biomarkers for acute respiratory distress syndrome [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(04): 471-475.
[3]	Zongjun Hu, Xi Yue, Xia Huang. Effect of bronchopulmonary segments recruitment on the survival of patients with severe acute respiratory distress syndrome [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(06): 796-800.
[4]	Hongmin Wang, Yunbo Xie, Yanhu Wang, Fusheng Wang. The advance of clinical research in mesenchymal stem cell treatment for COVID-19 [J]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2023, 13(04): 247-256.
[5]	Rui Chen, Hongna Yang, Wei Fang, Xinxin Li, Tiantian Li, Xiaoyi Yu, Yanxue Wang, Wenyu Li. Correlation between the cytokine levels in serum and BALF and intrapulmonary and extrapulmonary ARDS [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(03): 251-258.
[6]	Meiqing Wu, Jin Lin, Meili Duan, Xiaoyan Xue. Effect of high density lipoprotein level on the occurrence of sepsis-related acute respiratory distress syndrome [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(02): 191-197.
[7]	Dongyu Chen, Chun Pan, Yi Yang. Techniques to monitor respiratory effort in acute respiratory distress syndrome [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 84-88.
[8]	Jieqiong Wang, Huixia Wang, Huiying Zhao, Youzhong An. Regulation of angiotensin converting enzyme 2 on inflammatory injury of human pulmonary microvascular endothelial cells [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 78-83.
[9]	Jingen Xia, Shiyu Hu. Application scenario of extracorporeal carbon dioxide removal technology in Intensive Care Unit [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 40-45.
[10]	Chengfen Yin, Lei Xu. Talk about the timing of prone position ventilation again [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 9-13.
[11]	Yumei Wang, Yan Wang, Yimin Zhou, Mingyue Miao, Yanlin Yang, Linlin Zhang, Ming Xu, Jianxin Zhou. Application of regional recruitment-to-inflation ratio monitored by electrical impedance tomography in the models of acute respiratory distress syndrome [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 360-366.
[12]	Chengfen Yin, Lei Xu. Settings of mechanical ventilation during V-V ECMO support in ARDS patients [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 378-383.
[13]	Ling Liu, Huiying Zhao, Xuyan Li, Yuan Cheng, Qiaoxia Luo, Yun Yu, Yi Yang, Haibo Qiu. Bedside monitoring of spontaneous respiratory effort in patients with COVID-19 [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 367-370.
[14]	Yonghai Liu, Hang Qi, Ting Zhou, Wei Zhang. A case of community-acquired Acinetobacter baumannii pneumonia and a literature review [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(03): 276-280.
[15]	Danyang Tian, Xiaoxuan Liu, Shan Ye, Xinran Ma, Dongsheng Fan, Yu Fu. The impact of COVID-19 on the standardized training of neurology residents [J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(05): 499-504.

Please choose a citation manager

Content to export