Respiratory Failure
Conditions
Brief summary
Evaluation of awake prone position on ventilation inhomogeneity in COVID-19 associated respiratory failure.
Detailed description
Awake prone position has been proposed as an additional treatment to alleviate hypoxemia during COVID-19 acute respiratory failure and potentially to avoid in some case tracheal intubation and invasive ventilation. Potential mechanism is improvement of ventilation: perfusion mismatch through redistribution of ventilation to the dorsal part of the lungs where perfusion is prominent. Electrical impedance tomography (EIT) is a non-invasive functional lung imaging of distribution of ventilation. Therefore, we aim to assess EIT on lung ventilation inhomogeneity during supine and prone position in COVID-19 patients.
Interventions
OTHERphysiological effects of awake prone position in COVID 19 patients
Study of physiological effects of awake prone position in COVID 19 patients on lung inhomogeneity assessed by Electrical Impedance Tomography (EIT), gas exchange and dyspnea score (Borg Scale). Measurements will be performed at baseline (on supine position), then patients will be randomized on the order of position, either supine then prone, either prone then supine. Each period will last at least 2 hours. EIT records will be performed during the last 30 minutes of each period, blood gas and dyspnea score at the end of each period.
Sponsors
Assistance Publique Hopitaux De Marseille
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
SINGLE (Subject)
Intervention model description
Each patient will be his own control. The order of the experimental periods will be: 1. arm A: prone position followed by dorsal decubitus 2. arm B: dorsal decubitus followed by ventral decubitus A 30-minute wash-out period is set between the end of sequence 1 and the start of sequence 2.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* more than 18 Years (Adult, Older Adult) * Confirmed COVID-19 (positive SARS-CoV-2 RT-PCR at nasopharyngeal swab) * Acute respiratory failure with 100 \< PaO2:FiO2\< 300 mmhg * Spontaneous ventilation with standard oxygen supply or high flow humidified oxygen * Written informed consent of the patient
Exclusion criteria
* Contra-indication to prone position including pregnancy * Presence of pacemaker * Severe hypoxemia with PaO2/FiO2 \< 100 mmHg * Evidence of clinical signs of respiratory distress with high probability of intubation in the next two hours
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Global Inhomogeneity Index variations (expressed in percentage) between baseline, supine and prone position periods. | 2hours | Electrical Impedance Tomography (EIT) |
Countries
France
Contacts
STUDY_DIRECTORJean-Olivier ARNAUD
ASSISTANCE PUBLIQUE HÔPITAUX DE MARSEILLE
Outcome results
None listed