Prone positioning improves ventilation distribution and ventilation-perfusion matching assessed by electrical impedance tomography in COVID-19 patients with ARDS

doi:10.3877/cma.j.issn.2096-1537.2024.01.005

Abstract

Abstract:

Objective

To assess the impact of prone positioning (PP) on lung ventilation and perfusion in COVID-9 patients with moderate to severe acute respiratory distress syndrome (ARDS) using electrical impedance tomography (EIT), to investigate the effects of PP on the distribution of ventilation and oxygenation in non-intubated patients.

Methods

This prospective study comprised 15 patients with COVID-19 ARDS who received treatment in the prone position and were admitted to the Critical Care Medicine Department of Shanghai General Hospital, affiliated with Shanghai Jiaotong University, between December 2022 and February 2023. Arterial blood gas (ABG) analysis, ventilator parameters, and hemodynamic parameters of all patients at three-time points before the start of the prone position (T0), 2 hours after the start of the prone position (T1), 2 hours after the end of the prone position (T2) were collected. Measurements of heart rate (HR), mean arterial pressure (MAP), and EIT recordings were conducted simultaneously at T0, T1, and T2.

Results

After prone positioning, PaO₂/FiO₂ increased significantly [T0 vs T1 vs T2: (173.17±17.73) mmHg vs (257.05±57.39) mmHg vs (299.03±71.18) mmHg, F=15.270, P<0.001]. Additionally, there was an increase in the proportion of dorsal ventilation after PPV [T0 vs T1 vs T2: (39.87±18.74) % vs (62.20±18.70)% vs (51.40±18.43)%, F=9.340, P=0.001]. The minute ventilation (MV) was significantly increased [T0 vs T1 vs T2: (8.14±2.38) L/min vs (8.89±1.29) L/min vs (11.40±1.91) L/min, F=22.917, P<0.001, respectively]. Similarly, respiratory compliance (Crs) showed a substantial improvement at different time points [T0 vs T1 vs T2: (27.63±7.50) ml/cmH₂O vs (30.60±7.40) ml/cmH₂O vs (31.53±8.29)ml/cmH₂O, F=3.582, P=0.041, respectively]. The ventilation-perfusion matching showed a substantial improvement after PP compared to before PP [T0 vs T1: (66.67±12.81)% vs (78.24±10.60)%, P=0.03].

Conclusion

PP improves the uniformity of ventilation distribution and ventilation-perfusion matching in patients with COVID-19 ARDS.

Key words: Acute respiratory distress syndrome, Electrical impedance tomography, Prone positioning, Corona virus disease 2019

Jingjing Wang, Hui Xie, Puyu Deng, Chenchen Zhang, Xue Tian, Yun Xie, Ruilan Wang. Prone positioning improves ventilation distribution and ventilation-perfusion matching assessed by electrical impedance tomography in COVID-19 patients with ARDS[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(01): 31-37.

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Figures/Tables 6

References 28

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性别	年龄（岁）	BMI（kg/m²）	PaO₂/FiO₂（mmHg）	MAP（mmHg）	体温（℃）	APACHE Ⅱ评分（分）	PP时间（h）
男	68	25.61	172.00	97.67	38.0	14	45.0
女	87	21.08	151.00	88.33	36.3	23	45.0
男	87	19.03	199.78	58.67	37.6	20	23.0
男	66	24.49	170.20	81.33	39.2	30	45.0
男	76	22.68	158.67	88.00	37.6	28	42.0
男	79	22.60	199.99	102.33	37.4	16	19.0
女	73	17.58	166.00	112.00	37.0	21	18.0
男	79	23.14	151.00	92.00	39.0	32	19.5
男	70	23.18	183.08	61.67	36.5	20	48.0
男	73	23.03	180.00	80.67	38.2	16	48.0
男	65	19.03	91.07	83.67	38.9	24	48.0
女	69	16.53	90.00	78.00	37.0	18	29.5
男	73	23.03	127.75	116.33	36.5	21	28.0
男	78	26.81	147.50	69.00	36.8	22	48.0
男	58	29.76	114.55	104.00	36.6	16	22.0

性别	年龄（岁）	BMI（kg/m²）	PaO₂/FiO₂（mmHg）	MAP（mmHg）	体温（℃）	APACHE Ⅱ评分（分）	PP时间（h）
男	68	25.61	172.00	97.67	38.0	14	45.0
女	87	21.08	151.00	88.33	36.3	23	45.0
男	87	19.03	199.78	58.67	37.6	20	23.0
男	66	24.49	170.20	81.33	39.2	30	45.0
男	76	22.68	158.67	88.00	37.6	28	42.0
男	79	22.60	199.99	102.33	37.4	16	19.0
女	73	17.58	166.00	112.00	37.0	21	18.0
男	79	23.14	151.00	92.00	39.0	32	19.5
男	70	23.18	183.08	61.67	36.5	20	48.0
男	73	23.03	180.00	80.67	38.2	16	48.0
男	65	19.03	91.07	83.67	38.9	24	48.0
女	69	16.53	90.00	78.00	37.0	18	29.5
男	73	23.03	127.75	116.33	36.5	21	28.0
男	78	26.81	147.50	69.00	36.8	22	48.0
男	58	29.76	114.55	104.00	36.6	16	22.0

相关指标	T0	T1	T2	F值	主体内效应检验P值
PaCO₂（mmHg）	47.66±10.85	46.66±9.21	44.59±7.10	0.998	0.388
PaO₂/FiO₂（mmHg）	173.17±17.73	257.05±57.39^a	299.03±71.18^a	15.270	<0.001
Lac（mmol/L）	1.43±0.99	1.25±0.73	1.09±0.76	2.019	0.162
HR（次/min）	90.67±22.96	93.33±21.98	87.07±22.62	1.080	0.361
MAP（mmHg）	86.27±16.71	88.33±11.08	82.53±6.85	0.808	0.461
RR（次/min）	20.33±4.50	21.00±4.21	20.60±4.32	0.732	0.490
PEEP（cmH₂O）	8.67±0.98	9.07±1.28	9.20±1.26	1.492	0.261
MV（L/min）	8.14±2.38	8.89±1.29	11.40±1.91^a	22.917	<0.001
Crs（ml/cmH₂O）	27.63±7.50	30.60±7.40^a	31.53±8.29	3.582	0.041
Pplat	22.87±5.99	23.80±4.72	23.13±6.72	0.141	0.869

相关指标	T0	T1	T2	F值	主体内效应检验P值
PaCO₂（mmHg）	47.66±10.85	46.66±9.21	44.59±7.10	0.998	0.388
PaO₂/FiO₂（mmHg）	173.17±17.73	257.05±57.39^a	299.03±71.18^a	15.270	<0.001
Lac（mmol/L）	1.43±0.99	1.25±0.73	1.09±0.76	2.019	0.162
HR（次/min）	90.67±22.96	93.33±21.98	87.07±22.62	1.080	0.361
MAP（mmHg）	86.27±16.71	88.33±11.08	82.53±6.85	0.808	0.461
RR（次/min）	20.33±4.50	21.00±4.21	20.60±4.32	0.732	0.490
PEEP（cmH₂O）	8.67±0.98	9.07±1.28	9.20±1.26	1.492	0.261
MV（L/min）	8.14±2.38	8.89±1.29	11.40±1.91^a	22.917	<0.001
Crs（ml/cmH₂O）	27.63±7.50	30.60±7.40^a	31.53±8.29	3.582	0.041
Pplat	22.87±5.99	23.80±4.72	23.13±6.72	0.141	0.869

通气分布	T0	T1	T2	F值	主体内效应检验P值
GI	36.56±3.21	34.46±9.95	37.33±3.20	0.417	0.672
RVD[M（Q₂₅，Q₇₅）]	3（0，11）	0（0，3）	1（0，10）	7.069	0.017
通气ROI 1	17.40±8.52	9.80±9.29^a	15.87±9.59	8.006	0.002
通气ROI 2	42.73±13.48	28.13±12.43^a	32.73±13.30^a	6.641	0.004
通气ROI 3	30.13±11.67	45.73±12.65^a	37.13±11.41^a	11.261	<0.001
通气ROI 4	9.73±10.21	16.47±10.00^a	14.27±10.61^a	7.602	0.007
灌注ROI 1	20.09±9.35	14.99±8.05	20.31±7.58	1.425	0.266
灌注ROI 2	46.31±9.74	38.63±17.69	40.48±16.43	0.716	0.502
灌注ROI 3	24.77±9.86	34.96±15.91	38.63±13.25^a	3.339	0.058
灌注ROI 4	8.83±6.16	11.42±11.22	10.59±6.15	0.644	0.200
腹侧通气	60.13±18.74	37.93±18.57^a	48.60±18.43^a	9.180	0.001
背侧通气	39.87±18.74	62.20±18.70^a	51.40±18.43^a	9.340	0.001
腹侧血流	66.41±14.36	53.62±24.64	60.78±18.65	1.001	0.387
背侧血流	33.59±14.36	46.38±24.64	49.22±16.30^a	3.039	0.073
通气-灌注	66.67±12.81	78.24±10.60^a	73.90±9.77	3.798	0.069

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