Prone positioning monitored by electrical impedance tomography in patients with severe acute respiratory distress syndrome on veno-venous ECMO

Franchineau, Guillaume; Bréchot, Nicolas; Hékimian, Guillaume; Lebreton, Guillaume; Bourcier, Simon; Demondion, Pierre; Guennec, Loïc Le; Nieszkowska, Ania; Luyt, Charles‐Édouard; Combes, Alain; Schmidt, Matthieu

doi:10.1186/s13613-020-0633-5

Cited by 50 publications

(66 citation statements)

References 40 publications

(88 reference statements)

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“…No dislodgment of ECMO cannules when applying PP was reported [ 3 , 5 , 7 , 8 , 10 , 11 ]. Minor reversible complications were reported in 6% of subjects by Giani et al [ 5 ].…”

Section: Resultsmentioning

confidence: 99%

Effects of prone positioning during extracorporeal membrane oxygenation for refractory respiratory failure: a systematic review

Liu

Chen

et al. 2021

SN Compr. Clin. Med.

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As more and more studies have shown that venovenous extracorporeal membrane oxygenation (VV-ECMO) improves oxygenation and prognosis of critical patients, VV-ECMO has been frequently used in critical patients for severe acute respiratory distress syndrome (ARDS). Prone positioning (PP) is a postural therapy for ARDS, which permits for better ventilation/perfusion ratio (V/Q) matching, improvement of hypoxemia. Some articles revealed that performing PP during ECMO for refractory respiratory failure is feasible; however, the results obtained were controversial. Therefore, we performed a systematic review to further assess the effects of PP during ECMO for refractory respiratory failure. Six studies with 465 subjects were enrolled. Four articles examined changes of PaO2/FiO2 ratio after PP during VV-ECMO; PaO2/FiO2 ratio improved from 18.5 to 62 mmHg. Our analysis inferred that the PP-ECMO group did not have a significant advantage in survival at discharge (odds risk 1.42, 95% confidence interval 0.92-2.18; p = 0.11) compared with the ECMO group. We found that the PP-ECMO group had a significantly longer duration than the ECMO group (MD 5.37, 95% CI 4.19-6.54, I 2 = 67%, P < .00001). ICU length of stay in the PP-ECMO group was significantly longer than the ECMO group (MD 7.29, 95% CI 4.06-10.52, I 2 = 64%, P < .00001). No unplanned extubation of ECMO was recorded. In conclusion, our review found that performing PP during ECMO for refractory respiratory failure is safe and PP can improve the PaO2/FiO2 ratio, which is in line with the length of PP performed.

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“…No dislodgment of ECMO cannules when applying PP was reported [ 3 , 5 , 7 , 8 , 10 , 11 ]. Minor reversible complications were reported in 6% of subjects by Giani et al [ 5 ].…”

Section: Resultsmentioning

confidence: 99%

Effects of prone positioning during extracorporeal membrane oxygenation for refractory respiratory failure: a systematic review

Liu

Chen

et al. 2021

SN Compr. Clin. Med.

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“…2. EIT also had the potential to guide PEEP setting in prone position [ 29 , 30 ]. Over the entire hospital stay, more than 40% of patients received prone positioning.…”

Section: Discussionmentioning

confidence: 99%

Early individualized positive end-expiratory pressure guided by electrical impedance tomography in acute respiratory distress syndrome: a randomized controlled clinical trial

Chi

Yang

et al. 2021

Crit Care

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Background Individualized positive end-expiratory pressure (PEEP) by electrical impedance tomography (EIT) has potential interest in the optimization of ventilation distribution in acute respiratory distress syndrome (ARDS). The aim of the study was to determine whether early individualized titration of PEEP with EIT improved outcomes in patients with ARDS. Methods A total of 117 ARDS patients receiving mechanical ventilation were randomly assigned to EIT group (n = 61, PEEP adjusted based on ventilation distribution) or control group (n = 56, low PEEP/FiO2 table). The primary outcome was 28-day mortality. Secondary and exploratory outcomes were ventilator-free days, length of ICU stay, incidence of pneumothorax and barotrauma, and difference in Sequential Organ Failure Assessment (SOFA) score at day 1 (ΔD1-SOFA) and day 2 (ΔD2-SOFA) compared with baseline. Measurements and main results There was no statistical difference in the value of PEEP between the EIT group and control group, but the combination of PEEP and FiO2 was different between groups. In the control group, a significantly positive correlation was found between the PEEP value and the corresponding FiO2 (r = 0.47, p < 0.00001) since a given matched table was used for PEEP settings. Diverse combinations of PEEP and FiO2 were found in the EIT group (r = 0.05, p = 0.68). There was no significant difference in mortality rate (21% vs. 27%, EIT vs. control, p = 0.63), ICU length of stay (13.0 (7.0, 25.0) vs 10.0 (7.0, 14.8), median (25th–75th percentile); p = 0.17), and ventilator-free days at day 28 (14.0 (2.0, 23.0) vs 19.0 (0.0, 24.0), p = 0.55) between the two groups. The incidence of new barotrauma was zero. Compared with control group, significantly lower ΔD1-SOFA and ΔD2-SOFA were found in the EIT group (p < 0.001) in a post hoc comparison. Moreover, the EIT group exhibited a significant decrease of SOFA at day 2 compared with baseline (paired t-test, difference by − 1 (− 3.5, 0), p = 0.001). However, the control group did show a similar decrease (difference by 1 (− 2, 2), p = 0.131). Conclusion Our study showed a 6% absolute decrease in mortality in the EIT group: a statistically non-significant, but clinically non-negligible result. This result along with the showed improvement in organ function might justify further reserach to validate the beneficial effect of individualized EIT-guided PEEP setting on clinical outcomes of patients with ARDS. Trial registration: ClinicalTrials, NCT02361398. Registered 11 February 2015—prospectively registered, https://clinicaltrials.gov/show/NCT02361398.

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“…But the response to PP is unpredictable and can widely vary from one patient to another. Despite the difference, PP facilitates a greater survival rate among ventilated patients [28]. Patients with persistent severe ARDS have poor clinical outcomes.…”

Section: Sars and Mersmentioning

confidence: 99%

COVID-19 Compared with Other Viral Diseases: Novelties, Progress, and Challenges

Wang

Alexander

2020

Electron J Gen Med

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COVID-19 is a newly discovered, highly infectious disease and has rapidly spread into at least 213 countries as a pandemic. This paper is a comprehensive review article of COVID-19 and four other viral diseases, including influenza, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Ebola virus disease (EVD). The cause of COVID-19 is the novel coronavirus-SARS-CoV-2. The transmission of COVID-19 is complex and rapid; therefore, it is difficult to control the spread of the disease. Certified specific antiviral drugs are slowly becoming available for COVID-19, although a few treatments such as Remdesivir, hydroxychloroquine, dexamethasone, and therapeutic plasma exchange (TPE) have been found somewhat effective. Effective vaccines are still in the process of development and several countries, including the USA are conducting Phase 3 trials currently to fast-track the vaccines. All these issues have created significant challenges in reducing the morbidity and mortality of this global infectious disease. COVID-19 has led to vast impacts on public health and the global economy. With economic shutdowns, social distancing, increased handwashing, and sanitizing have been first line therapies for mitigating the spread of COVID-19 and have created a new normal. COVID-19 is different from influenza and previous pandemic diseases, such as SARS, MERS, and EVD, but has some similarities to them. Influenza and these pandemic diseases are introduced in this paper as a comparison with COVID-19. The features of COVID-19, progress achieved in treatment, emerging technologies in testing and diagnosis, and current and future challenges are presented. Specifically, topics regarding COVID-19 in this paper cover basic facts, the questionable origin of COVID-19, testing and diagnosis, pharmaceutical treatment and comfort measures, strategies and management for fighting against COVID-19, and the emotional, psychological, and mental health impacts of shelter-in-place orders and quarantine of COVID-19.

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Prone positioning monitored by electrical impedance tomography in patients with severe acute respiratory distress syndrome on veno-venous ECMO

Cited by 50 publications

References 40 publications

Effects of prone positioning during extracorporeal membrane oxygenation for refractory respiratory failure: a systematic review

Effects of prone positioning during extracorporeal membrane oxygenation for refractory respiratory failure: a systematic review

Early individualized positive end-expiratory pressure guided by electrical impedance tomography in acute respiratory distress syndrome: a randomized controlled clinical trial

COVID-19 Compared with Other Viral Diseases: Novelties, Progress, and Challenges

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