Electric Impedance, Prone Positioning, Severe Acute Respiratory Syndrome Coronavirus 2
Conditions
Brief summary
The consensus therapeutic strategy implies that COVID patients with acute lung injury due to coronavirus are routinely placed in prone position in an attempt to improve oxygenation by increasing ventilation homogeneity. The purpose of the study is to quantify with the electrical impedance tomography (EIT) the changes in the ventilation and aeration in the dorsal regions of the lung when the patient is placed in prone position.
Detailed description
Patients with acute respiratory distress syndrome (ARDS) frequently develop atelectasis in dorsal lung regions because of gravity and the compression by the heart and the diaphragm. Since lung perfusion is predominantly distributed in lower lung regions, a reduction of ventilation in these areas results in further ventilation-perfusion mismatch, called shunt. The development of atelectatic lung regions necessitate the use of higher ventilation pressures, which in turn results in excessive transpulmonary pressures and ventilation-induced lung injury in the ventral regions. Therefore it is common to promote the prone position in patients with ARDS in order to improve ventilation-perfusion matching and thus, protect the ventral regions from hyperinflation. In patients with COVID-19-related ARDS, the value of such therapeutic strategy based on placing in prone position has not been completely elucidated. The aims of the study are to determine whether prone positioning improves dorsal regional ventilation when compared to supine position. Moreover, another aim is to assess the changes in intrapulmonary shunt following patient position changes.
Interventions
OTHERProne positioning
Change the positioning of the COVID patients who are intubated and mechanically ventilated from supine to prone
Sponsors
Walid HABRE
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Patients fulfilling all the following criteria are eligible for the study: * Mechanically ventilated * Fit the Berlin Definition for moderate or severe acute respiratory distress syndrome (arterial oxygen partial pressure over inspiratory fraction of oxygen less than 200 mmHg) * Infection with coronavirus confirmed * Scheduled to undergo prone positioning
Exclusion criteria
* Patients with pacemakers, defibrillators or other electrically active implants * Patients with damaged skin or impaired skin contact of the electrodes due to wound dressings * Patients with chest tubes * History of thoracic surgery or lung resection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tidal electrical Impedance | One hour before turning to prone or supine positioning | Change in the ratio of tidal electrical impedance variation in the dorsal and total lung areas |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intrapulmonary shunt | One hour before turning to prone or supine positioning | Changes in intrapulmonary shunt fraction |
| Volumetric capnography | One hour before turning to prone or supine positioning | Changes in the phase three slope of the volumetric capnogram |
Countries
Switzerland
Outcome results
None listed