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- Title
Clinical features and respiratory pathophysiology of COVID-19 patients ventilated in the prone position: a cohort study.
- Authors
Sastre, José A.; López, Teresa; Vaquero-Roncero, Luis M.; Sánchez-Barrado, María E.; Martín-Moreno, María A.; Arribas, Pilar; Hernández, Azucena; Garrido-Gallego, Isabel; Sánchez-Hernández, Miguel V.
- Abstract
Background: There are few studies that have investigated the response to the prone position in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome (ARDS). We describe the characteristics and outcomes of those patients in a tertiary hospital in Spain. Methods: This is an observational study in consecutive, mechanically ventilated COVID-19 patients. The primary endpoint was to describe the respiratory pathophysiology and clinical outcomes of COVID-19 patients treated by mechanical ventilation in the prone position. Results: Of 84 patients mechanically ventilated in the prone position, 19 (22%) were successfully extubated and 43 (51%) were discharged from the ICU. The duration of mechanical ventilation and ICU length of stay were 11 days (IQR 8--16) and 15 days (IQR 9--25), respectively. On admission to ICU, 61% patients had a moderate ARDS according to the Berlin criteria. 76% had 4 lung quadrants affected. After intubation, the median PaO2/FiO2 was 105 (IQR 76--138), ventilatory ratio was 1.48 (IQR 1.16--1.88), and compliance was 33 mL cm H2O--1 (IQR 25--41). The median number of cycles in the prone position was 2 (1--3), with a median of total hours in the prone position of 76 (IQR 64--111). 72 h after the first prone position cycle the median PaO2/FiO2 increase was up to 193 (IQR 152--251), but the compliance was similar to the basal level (34 mL cm H2O--1 [IQR 26--43]). However, the percentage of patients with normal compliance (> 50 mL cm H2O--1) increased with the prone position from 15% (n = 13) to 32% (n = 27) after 72 h. Conclusions: In our study, the COVID-19 patients with respiratory failure presented respiratory mechanics, gas exchange parameters, and a response to prone ventilation similar to those observed in other causes of ARDS.
- Subjects
SPAIN; LENGTH of stay in hospitals; INTENSIVE care units; COVID-19; SCIENTIFIC observation; RESPIRATORY insufficiency; SARS-CoV-2; BLOOD gases analysis; TIME; LUNG diseases; TERTIARY care; TREATMENT duration; EXTRACORPOREAL membrane oxygenation; RESPIRATORY measurements; LUNG physiology; ADULT respiratory distress syndrome; ARTIFICIAL respiration; TREATMENT effectiveness; SYMPTOMS; DESCRIPTIVE statistics; DATA analysis software; RESPIRATORY mechanics; LONGITUDINAL method; INTERMITTENT positive pressure breathing
- Publication
Anaesthesiology Intensive Therapy / Anestezjologia, Intensywna Terapia, 2021, Vol 53, Issue 4, p319
- ISSN
1642-5758
- Publication type
Article
- DOI
10.5114/ait.2021.109392