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Lung impedance changes during awake prone positioning in COVID-19. A non-randomized cross-over study
Jacob Rosén1, Peter Frykholm1, Malin Jonsson Fagerlund2,3
1Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Plos One
|February 21, 2024
Summary
Awake prone positioning (APP) transiently increased lung recruitment in COVID-19 patients, as measured by electrical lung impedance tomography (EIT). Ventilation distribution did not change, indicating APP
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Medical Imaging
Background:
- Awake prone positioning (APP) is used for hypoxemic respiratory failure in COVID-19 patients.
- Its precise effects on respiratory mechanics, particularly lung volumes and ventilation distribution, remain incompletely understood.
- Electrical lung impedance tomography (EIT) offers a method for regional lung assessment.
Purpose of the Study:
- To investigate changes in global and regional lung volumes during APP.
- To compare respiratory mechanics in APP versus supine positions using EIT.
- To assess the impact of APP on ventilation distribution in COVID-19 patients.
Main Methods:
- Exploratory, non-randomized cross-over study in two Swedish university hospitals (Jan-May 2021).
- Included 10 ICU patients with COVID-19, hypoxemic respiratory failure, and receiving high-flow nasal oxygen or non-invasive ventilation.
- EIT data recorded at supine baseline, during APP (30 and 60 min), and after returning to supine.
Main Results:
- Awake prone positioning (APP) led to a significant increase in global and regional delta end-expiratory lung-impedance (dEELI), indicating lung recruitment.
- No significant changes were observed in global or regional tidal impedance variation (TIV), center of ventilation (CoV), or global inhomogeneity (GI) index.
- The observed lung recruitment effect was transient, returning to baseline after repositioning to supine.
Conclusions:
- Awake prone positioning (APP) demonstrated a transient lung recruiting effect in COVID-19 patients with hypoxemic respiratory failure.
- EIT measurements showed no significant changes in ventilation distribution during APP.
- APP may promote lung recruitment without altering ventilation patterns in this patient group.
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