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Updated: Jun 3, 2025

An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
Ventilation-perfusion matching in early-stage of prone position ventilation: a prospective cohort study between
Yingying Yang1, Hantian Li2, Yi Chi1
1State Key Laboratory of Complex Severe and Rare Disease, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Abstract:
Objective.Prone positioning has been established as a therapeutic strategy for severe acute respiratory distress syndrome (ARDS). In COVID-19-associated ARDS (CARDS), the application of prone position has shown varying responses, influenced by factors such as lung recruitability and SARS-CoV-2-induced pulmonary endothelial dysfunction. This study aimed to compare the early impact of pronation on lung ventilation-perfusion matching (VQmatch) in CARDS and non-COVID-19 ARDS patients (non-CARDS).Approach.This was a two-center, prospective study comparing between CARDS and non-CARDS. Electrical impedance tomography (EIT) was used to compare the VQmatch between supine and early-stage prone positions (∼2 h). The study identified the areas of Deadspace, shunt, and VQmatch. Within the defined VQmatch region, the global inhomogeneity index (VQmatch-GI) was computed to evaluate the degree of heterogeneity. Paired Wilcoxon signed-rank test and Chi-square test were used in statistical analysis.Main results.15 CARDS patients and 14 non-CARDS patients undergoing mechanical ventilation were included. In comparison to the non-CARDS group, the CARDS group exhibited a higher prevalence of diffuse lung disease (15 [100%] vs. 4 [28.6%], CARDS vs. Non-CARDS,p< 0.001), along with elevated SOFA score, PCO2, PEEP, and Ppeak. Among non-CARDS patients, 11/14 demonstrated improved oxygenation, whereas only 5/15 CARDS patients exhibited oxygenation improvement in prone ventilation. In 13/29 patients with oxygenation improvement (defined as above 20% increase in SpO2/FiO2), there was a significant decreased deadspace (21.3 [11.5, 33.1] vs. 9.7 [7.3, 16.9],p= 0.039), and VQmatch showed an upward trend. When comparing prone ventilation to supine ventilation, non-CARDS patients showed a significant improvement in overall VQmatch (Supine 65.7 [49.7, 68.5] vs. Prone 67.4 [60.8, 72.6],p= 0.019). CARDS patients had a notable decrease in ventral VQmatch (VQmatch_Ventral: Supine 35.0 [26.9, 42.0] vs. Prone 22.7 [12.4, 32.9],p= 0.003), and an improvement in dorsal VQmatch (VQmatch_Dorsal: Supine 33.4 [20.4, 39.4] vs. Prone 46.4 [37.4, 48.4],p= 0.031), leading to no significant improvement in overall VQmatch. Ten CARDS patients with no improvement in VQmatch had increased shunting and VQmatch-GI.Significance.In non-CARDS patients, the improvement in oxygenation and VQmatch following prone positioning exhibits a consistent pattern. Conversely, in CARDS patients, the impact of prone positioning reveals considerable individual variability. This study indicates that the response to short-time prone ventilation can vary in ARDS patients with different etiologies.Trial registration:NCT05816928, 04/17/2023, retrospectively registered. Ventilation-Perfusion Matching in Early-stage Prone Position Ventilation, NCT05816928. Registered 17 April 2023 - Retrospectively registered,https://clinicaltrials.gov/study/NCT05816928.
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