Lung Recruiting Effect of Prone Positioning in Spontaneously Breathing Patients with COVID-19 Assessed by Electrical Impedance Tomography

Brunin, Yannick; Despres, Cyrielle; Pili-Floury, Sébastien; Besch, Guillaume

doi:10.1164/rccm.202008-3044im

Cited by 12 publications

(6 citation statements)

References 4 publications

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“…Dorsal and ventral ventilations increase, whereas GI and pleural pressure swings decrease, possibly leading to less lung collapse and strain (68). EIT has also been used to assess lung recruitment and improvements in ventilation homogeneity during awake PP (69) and is currently under study (ProneSpontCov NCT04632602) (70).…”

Section: Clinical Studies In the Initial Management Of Acute Respirat...mentioning

confidence: 99%

Electrical Impedance Tomography in Acute Respiratory Distress Syndrome Management

Jiménez

Weirauch

Culter

et al. 2022

Critical Care Medicine

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To describe, through a narrative review, the physiologic principles underlying electrical impedance tomography, and its potential applications in managing acute respiratory distress syndrome (ARDS). To address the current evidence supporting its use in different clinical scenarios along the ARDS management continuum. DATA SOURCES:We performed an online search in Pubmed to review articles. We searched MEDLINE, Cochrane Central Register, and clinicaltrials.gov for controlled trials databases. STUDY SELECTION:Selected publications included case series, pilot-physiologic studies, observational cohorts, and randomized controlled trials. To describe the rationale underlying physiologic principles, we included experimental studies.DATA EXTRACTION: Data from relevant publications were reviewed, analyzed, and its content summarized.DATA SYNTHESIS: Electrical impedance tomography is an imaging technique that has aided in understanding the mechanisms underlying multiple interventions used in ARDS management. It has the potential to monitor and predict the response to prone positioning, aid in the dosage of flow rate in high-flow nasal cannula, and guide the titration of positive-end expiratory pressure during invasive mechanical ventilation. The latter has been demonstrated to improve physiologic and mechanical parameters correlating with lung recruitment. Similarly, its use in detecting pneumothorax and harmful patient-ventilator interactions such as pendelluft has been proven effective. Nonetheless, its impact on clinically meaningful outcomes remains to be determined. CONCLUSIONS:Electrical impedance tomography is a potential tool for the individualized management of ARDS throughout its different stages. Clinical trials should aim to determine whether a specific approach can improve clinical outcomes in ARDS management.

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Section: Clinical Studies In the Initial Management Of Acute Respirat...mentioning

confidence: 99%

Electrical Impedance Tomography in Acute Respiratory Distress Syndrome Management

Jiménez

Weirauch

Culter

et al. 2022

Critical Care Medicine

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“…EIT can also be used to monitor spontaneously breathing patients. Brunin et al [ 34 ] described a spontaneously breathing obese patient with C-ARDS, low oxygenation and high respiratory rate with a high risk of intubation. In prone position EIT, showed a large increase in ventilation, mainly in the dorsal regions, compared with the supine position.…”

Section: Volumes and Aerationmentioning

confidence: 99%

Advanced respiratory monitoring in mechanically ventilated patients with coronavirus disease 2019-associated acute respiratory distress syndrome

Somhorst

Gommers

Endeman

2021

Current Opinion in Critical Care

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Purpose of review To summarize the current knowledge about the application of advanced monitoring techniques in coronavirus disease 2019 (COVID-19). Recent findings Due to the heterogeneity between patients, management of COVID-19 requires daily monitoring of and/or aeration and inspiratory effort. Electrical impedance tomography can be used to optimize positive end-expiratory pressure, monitor the response to changes in treatment or body position and assess pulmonary perfusion and ventilation/perfusion matching. Lung ultrasound is more readily available and can be used to measure and monitor recruitment, provide an indication of diaphragm function and pulmonary perfusion disturbances. Esophageal pressure measurements enable the calculation of the transpulmonary pressure and inspiratory effort in order to prevent excessive stress on the lung. While esophageal pressure measurements are the golden standard in determining inspiratory effort, alternatives like P 0.1 , negative pressure swing during a single airway occlusion and change in central venous pressure are more readily available and capable of diagnosing extreme inspiratory efforts. Summary Although there is little data on the effectiveness of advanced monitoring techniques in COVID-19, regular monitoring should be a central part of the management of COVID-19-related acute respiratory distress syndrome (C-ARDS).

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“…Although the effects of prone positioning on lung physiology are well established among intubated patients with moderate to severe acute respiratory distress syndrome (ARDS) [ 11 ], they have not been thoroughly investigated during APP in patients with respiratory failure [ 12 ]. Specifically, few studies describe the effects of APP on global and regional ventilation in patients with hypoxemic respiratory failure due to COVID-19 [ 13 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…In one case report of a COVID-19 patient, end-expiratory lung impedance (EELI) measured by EIT increased during APP [ 13 ]. As EELI correlates to end-expiratory lung volume [ 27 ] this was interpreted as alveolar recruitment and suggested to contribute to the observed coincident improvement in oxygenation.…”

Section: Introductionmentioning

confidence: 99%

Lung impedance changes during awake prone positioning in COVID-19. A non-randomized cross-over study

Rosén,

Frykholm,

Jonsson Fagerlund

et al. 2024

PLoS ONE

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Background The effects of awake prone positioning (APP) on respiratory mechanics in patients with COVID-19 are not well characterized. The aim of this study was to investigate changes of global and regional lung volumes during APP compared with the supine position using electrical lung impedance tomography (EIT) in patients with hypoxemic respiratory failure due to COVID-19. Materials and methods This exploratory non-randomized cross-over study was conducted at two university hospitals in Sweden between January and May 2021. Patients admitted to the intensive care unit with confirmed COVID-19, an arterial cannula in place, a PaO2/FiO2 ratio <26.6 kPa (<200 mmHg) and high-flow nasal oxygen or non-invasive ventilation were eligible for inclusion. EIT-data were recorded at supine baseline, at 30 and 60 minutes after APP-initiation, and 30 minutes after supine repositioning. The primary outcomes were changes in global and regional tidal impedance variation (TIV), center of ventilation (CoV), global and regional delta end-expiratory lung-impedance (dEELI) and global inhomogeneity (GI) index at the end of APP compared with supine baseline. Data were reported as median (IQR). Results All patients (n = 10) were male and age was 64 (47–73) years. There were no changes in global or regional TIV, CoV or GI-index during the intervention. dEELI increased from supine reference value 0 to 1.51 (0.32–3.62) 60 minutes after APP (median difference 1.51 (95% CI 0.19–5.16), p = 0.04) and returned to near baseline values after supine repositioning. Seven patients (70%) showed an increase >0.20 in dEELI during APP. The other EIT-variables did not change during APP compared with baseline. Conclusion Awake prone positioning was associated with a transient lung recruiting effect without changes in ventilation distribution measured with EIT in patients with hypoxemic respiratory failure due to COVID-19.

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Lung Recruiting Effect of Prone Positioning in Spontaneously Breathing Patients with COVID-19 Assessed by Electrical Impedance Tomography

Cited by 12 publications

References 4 publications

Electrical Impedance Tomography in Acute Respiratory Distress Syndrome Management

Electrical Impedance Tomography in Acute Respiratory Distress Syndrome Management

Advanced respiratory monitoring in mechanically ventilated patients with coronavirus disease 2019-associated acute respiratory distress syndrome

Lung impedance changes during awake prone positioning in COVID-19. A non-randomized cross-over study

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