Prone positioning may increase lung overdistension in COVID-19-induced ARDS

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Medical Imaging

Background:

• Mechanical ventilation in COVID-19 ARDS requires careful management of lung volumes.
• Regional lung overdistension and collapse are significant concerns.
• Real-time monitoring of these effects is challenging.

Purpose of the Study:

• To individualize positive end-expiratory pressure (PEEP) in supine and prone positions for COVID-19 ARDS patients.
• To reduce lung collapse and overdistension using bedside PEEP titration.
• To investigate the effects of body position on lung mechanics.

Main Methods:

• Prospective observational study of mechanically ventilated COVID-19 ARDS patients.
• Utilized electrical impedance tomography (EIT) with a decremental PEEP titration algorithm (PEEP_{EIT-titration}).
• Performed PEEP_{EIT-titration} in both supine and prone positions after lung recruitment maneuvers.

Main Results:

• Prone positioning showed increased overdistension at PEEP > 10 cmH₂O compared to supine.
• Supine positioning resulted in greater lung collapse at lower PEEP levels.
• Respiratory system compliance was significantly lower in the prone position.

Conclusions:

• Prone positioning decreases lung collapse but can increase overdistension at higher PEEP levels in COVID-19 ARDS.
• Individualized PEEP titration with EIT is essential for optimizing ventilation strategies.
• Body position significantly impacts regional lung mechanics during mechanical ventilation.