tetano
Editor, Senior Moderator
J Clin Med
. 2020 Dec 21;9(12):E4129.
doi: 10.3390/jcm9124129.
Effects of Prone Ventilation on Oxygenation, Inflammation, and Lung Infiltrates in COVID-19 Related Acute Respiratory Distress Syndrome: A Retrospective Cohort Study
Rohit Khullar[SUP] 1 [/SUP], Shrey Shah[SUP] 2 [/SUP], Gagandeep Singh[SUP] 3 [/SUP], Joseph Bae[SUP] 1 [/SUP], Rishabh Gattu[SUP] 3 [/SUP], Shubham Jain[SUP] 4 [/SUP], Jeremy Green[SUP] 3 [/SUP], Thiruvengadam Anandarangam[SUP] 2 [/SUP], Marc Cohen[SUP] 5 [/SUP], Nikhil Madan[SUP] 2 [/SUP], Prateek Prasanna[SUP] 6 [/SUP]
Affiliations
Abstract
Patients receiving mechanical ventilation for coronavirus disease 2019 (COVID-19) related, moderate-to-severe acute respiratory distress syndrome (CARDS) have mortality rates between 76-98%. The objective of this retrospective cohort study was to identify differences in prone ventilation effects on oxygenation, pulmonary infiltrates (as observed on chest X-ray (CXR)), and systemic inflammation in CARDS patients by survivorship and to identify baseline characteristics associated with survival after prone ventilation. The study cohort included 23 patients with moderate-to-severe CARDS who received prone ventilation for ≥16 h/day and was segmented by living status: living (n = 6) and deceased (n = 17). Immediately after prone ventilation, PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] improved by 108% (p < 0.03) for the living and 150% (p < 3 ? 10[SUP]-4[/SUP]) for the deceased. However, the 48 h change in lung infiltrate severity in gravity-dependent lung zones was significantly better for the living than for the deceased (p < 0.02). In CXRs of the lower lungs before prone ventilation, we observed 5 patients with confluent infiltrates bilaterally, 12 patients with ground-glass opacities (GGOs) bilaterally, and 6 patients with mixed infiltrate patterns; 80% of patients with confluent infiltrates were alive vs. 8% of patients with GGOs. In conclusion, our small study indicates that CXRs may offer clinical utility in selecting patients with moderate-to-severe CARDS who will benefit from prone ventilation. Additionally, our study suggests that lung infiltrate severity may be a better indicator of patient disposition after prone ventilation than PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB].
Keywords: acute respiratory distress syndrome (ARDS); chest imaging; coronavirus disease 2019 (COVID-19); diagnostic radiology; prone positioning; prone ventilation; severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2).
. 2020 Dec 21;9(12):E4129.
doi: 10.3390/jcm9124129.
Effects of Prone Ventilation on Oxygenation, Inflammation, and Lung Infiltrates in COVID-19 Related Acute Respiratory Distress Syndrome: A Retrospective Cohort Study
Rohit Khullar[SUP] 1 [/SUP], Shrey Shah[SUP] 2 [/SUP], Gagandeep Singh[SUP] 3 [/SUP], Joseph Bae[SUP] 1 [/SUP], Rishabh Gattu[SUP] 3 [/SUP], Shubham Jain[SUP] 4 [/SUP], Jeremy Green[SUP] 3 [/SUP], Thiruvengadam Anandarangam[SUP] 2 [/SUP], Marc Cohen[SUP] 5 [/SUP], Nikhil Madan[SUP] 2 [/SUP], Prateek Prasanna[SUP] 6 [/SUP]
Affiliations
- PMID: 33371426
- DOI: 10.3390/jcm9124129
Abstract
Patients receiving mechanical ventilation for coronavirus disease 2019 (COVID-19) related, moderate-to-severe acute respiratory distress syndrome (CARDS) have mortality rates between 76-98%. The objective of this retrospective cohort study was to identify differences in prone ventilation effects on oxygenation, pulmonary infiltrates (as observed on chest X-ray (CXR)), and systemic inflammation in CARDS patients by survivorship and to identify baseline characteristics associated with survival after prone ventilation. The study cohort included 23 patients with moderate-to-severe CARDS who received prone ventilation for ≥16 h/day and was segmented by living status: living (n = 6) and deceased (n = 17). Immediately after prone ventilation, PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] improved by 108% (p < 0.03) for the living and 150% (p < 3 ? 10[SUP]-4[/SUP]) for the deceased. However, the 48 h change in lung infiltrate severity in gravity-dependent lung zones was significantly better for the living than for the deceased (p < 0.02). In CXRs of the lower lungs before prone ventilation, we observed 5 patients with confluent infiltrates bilaterally, 12 patients with ground-glass opacities (GGOs) bilaterally, and 6 patients with mixed infiltrate patterns; 80% of patients with confluent infiltrates were alive vs. 8% of patients with GGOs. In conclusion, our small study indicates that CXRs may offer clinical utility in selecting patients with moderate-to-severe CARDS who will benefit from prone ventilation. Additionally, our study suggests that lung infiltrate severity may be a better indicator of patient disposition after prone ventilation than PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB].
Keywords: acute respiratory distress syndrome (ARDS); chest imaging; coronavirus disease 2019 (COVID-19); diagnostic radiology; prone positioning; prone ventilation; severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2).