Awake prone position reduces work of breathing in patients with COVID-19 ARDS supported by CPAP

Annals of Intensive Care

Elena Chiodaroli¹  Silvia Coppola¹  Davide Chiumello²  Matteo Pitimada³  Simone Cappio Borlino³  Claudia Granata³  Pedro David Wendel Garcia⁴ 

[1] Department of Anesthesia and Intensive Care, ASST Santi Paolo E Carlo, San Paolo University Hospital, Via A. di Rudinì 8, Milan, Italy;Department of Anesthesia and Intensive Care, ASST Santi Paolo E Carlo, San Paolo University Hospital, Via A. di Rudinì 8, Milan, Italy;Department of Health Sciences, University of Milan, Milan, Italy;Coordinated Research Center On Respiratory Failure, University of Milan, Milan, Italy;Department of Health Sciences, University of Milan, Milan, Italy;Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland;

关键词: Continuous positive airway pressure;    Awake prone position;    Helmet CPAP;    ARDS;    COVID-19;    Work of breathing;   

DOI  :  10.1186/s13613-021-00967-6

来源: Springer

【 摘 要 】

BackgroundThe use of awake prone position concomitant to non-invasive mechanical ventilation in acute respiratory distress syndrome (ARDS) secondary to COVID-19 has shown to improve gas exchange, whereas its effect on the work of breathing remain unclear. The objective of this study was to evaluate the effects of awake prone position during helmet continuous positive airway pressure (CPAP) ventilation on inspiratory effort, gas exchange and comfort of breathing.MethodsForty consecutive patients presenting with ARDS due to COVID-19 were prospectively enrolled. Gas exchange, esophageal pressure swing (ΔPes), dynamic transpulmonary pressure (dTPP), modified pressure time product (mPTP), work of breathing (WOB) and comfort of breathing, were recorded on supine position and after 3 h on prone position.ResultsThe median applied PEEP with helmet CPAP was 10 [8–10] cmH2O. The PaO2/FiO2 was higher in prone compared to supine position (Supine: 166 [136–224] mmHg, Prone: 314 [232–398] mmHg, p < 0.001). Respiratory rate and minute ventilation decreased from supine to prone position from 20 [17–24] to 17 [15–19] b/min (p < 0.001) and from 8.6 [7.3–10.6] to 7.7 [6.6–8.6] L/min (p < 0.001), respectively. Prone position did not reduce ΔPes (Supine: − 7 [− 9 to − 5] cmH2O, Prone: − 6 [− 9 to − 5] cmH2O, p = 0.31) and dTPP (Supine: 17 [14–19] cmH2O, Prone: 16 [14–18] cmH2O, p = 0.34). Conversely, mPTP and WOB decreased from 152 [104–197] to 118 [90–150] cmH2O/min (p < 0.001) and from 146 [120–185] to 114 [95–151] cmH2O L/min (p < 0.001), respectively. Twenty-six (65%) patients experienced a reduction in WOB of more than 10%. The overall sensation of dyspnea was lower in prone position (p = 0.005).ConclusionsAwake prone position with helmet CPAP enables a reduction in the work of breathing and an improvement in oxygenation in COVID-19-associated ARDS.

【 授权许可】

CC BY