Burton-Papp Helmi C, Jackson Alexander I R, Beecham Ryan, Ferrari Matteo, Nasim-Mohi Myra, Grocott Michael P W, Chambers Robert, Dushianthan Ahilanandan
General Intensive Care unit, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, SO16 6YD, UK.
NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, SO16 6YD, UK.
F1000Res. 2020 Jul 31;9:859. doi: 10.12688/f1000research.25384.1. eCollection 2020.
Critically ill patients admitted to hospital following SARS-CoV-2 infection often experience hypoxic respiratory failure and a proportion require invasive mechanical ventilation to maintain adequate oxygenation. The combination of prone positioning and non-invasive ventilation in conscious patients may have a role in improving oxygenation. The purpose of this study was to assess the effect of prone positioning in spontaneously ventilating patients receiving non-invasive ventilation admitted to the intensive care. Clinical data of 81 patients admitted with COVID 19 pneumonia and acute hypoxic respiratory failure were retrieved from electronic medical records and examined. Patients who had received prone positioning in combination with non-invasive ventilation were identified. A total of 20 patients received prone positioning in conjunction with non-invasive ventilation. This resulted in improved oxygenation as measured by a change in PaO /FiO (P/F) ratio of 28.7 mmHg while prone, without significant change in heart rate or respiratory rate. Patients on average underwent 5 cycles with a median duration of 3 hours. There were no reported deaths, 7 of the 20 patients (35%) failed non-invasive ventilation and subsequently required intubation and mechanical ventilation. In our cohort of 20 COVID-19 patients with moderate acute hypoxic respiratory failure, prone positioning with non-invasive ventilation resulted in improved oxygenation. Prone positioning with non-invasive ventilation may be considered as an early therapeutic intervention in COVID-19 patients with moderate acute hypoxic respiratory failure.
新型冠状病毒2感染后入院的危重症患者常出现低氧性呼吸衰竭，部分患者需要有创机械通气以维持足够的氧合。对于意识清醒的患者，俯卧位通气与无创通气联合使用可能有助于改善氧合。本研究旨在评估俯卧位通气对入住重症监护病房且接受无创通气的自主呼吸患者的影响。我们从电子病历中检索并分析了81例因新冠肺炎肺炎和急性低氧性呼吸衰竭入院患者的临床资料，识别出接受俯卧位通气联合无创通气的患者。共有20例患者接受了俯卧位通气联合无创通气，这使患者在俯卧时的氧合得到改善，动脉血氧分压/吸入氧浓度（PaO₂/FiO₂，P/F）比值变化了28.7 mmHg，心率和呼吸频率无显著变化。患者平均进行了5个周期，中位持续时间为3小时。无死亡报告，20例患者中有7例（35%）无创通气失败，随后需要气管插管和机械通气。在我们这组20例中度急性低氧性呼吸衰竭的新冠肺炎患者中，俯卧位通气联合无创通气可改善氧合。对于中度急性低氧性呼吸衰竭的新冠肺炎患者，俯卧位通气联合无创通气可被视为一种早期治疗干预措施。
