Vollenberg Richard, Matern Philipp, Nowacki Tobias, Fuhrmann Valentin, Padberg Jan-Sören, Ochs Kevin, Schütte-Nütgen Katharina, Strauß Markus, Schmidt Hartmut, Tepasse Phil-Robin
Department of Medicine B, Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology, University Hospital Muenster, 48149 Muenster, Germany.
Department of Medicine, Gastroenterology, Marienhospital Steinfurt, 48565 Steinfurt, Germany.
J Clin Med. 2021 Mar 3;10(5):1046. doi: 10.3390/jcm10051046.
The prone position (PP) is increasingly used in mechanically ventilated coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) patients. However, studies investigating the influence of the PP are currently lacking in these patients. This is the first study to investigate the influence of the PP on the oxygenation and decarboxylation in COVID-19 patients.
A prospective bicentric study design was used, and in mechanically ventilated COVID-19 patients, PP was indicated from a partial pressure of oxygen in arterial blood (P)/fraction of inspired oxygen (F) ratio of <200. Patients were left prone for 16 h each. Pressure levels, F, were adjusted to ensure a P greater than 60 mmHg. Blood gas analyses were performed before (baseline 0.5 h), during (1/2/5.5/9.5/13 h), and after being in the PP (1 h), the circulatory/ventilation parameters were continuously monitored, and lung compliance (LC) was roughly calculated. Responders were defined compared to the baseline value (P/F ratio increase of ≥15%; partial pressure of carbon dioxide (P) decrease of ≥2%).
13 patients were included and 36 PP sessions were conducted. Overall, P/F increased significantly in the PP ( < 0.001). Most P/F responders (29/36 PP sessions, 77%) were identified 9.5 h after turning prone (14% slow responders), while most P responders (15/36 PP sessions, 42%) were identified 13 h after turning prone. A subgroup of patients (interval intubation to PP ≥3 days) showed less P/F responders (16% vs. 77%). An increase in P and minute ventilation in the PP showed a significant negative correlation ( < 0.001). LC (median before the PP = 38 mL/cm HO; two patients with LC >80 mL/cm HO) showed a significant positive correlation with the 28 day survival of patients ( = 0.01).
The PP significantly improves oxygenation in COVID-19 ARDS patients. The data suggest that they also benefit most from an early PP. A decrease in minute ventilation may result in fewer P responders. LC may be a predictive outcome parameter in COVID-19 patients.
Retrospectively registered.
俯卧位（PP）越来越多地用于接受机械通气的2019冠状病毒病（COVID-19）急性呼吸窘迫综合征（ARDS）患者。然而，目前缺乏关于PP对这些患者影响的研究。这是第一项研究PP对COVID-19患者氧合和脱羧作用影响的研究。
采用前瞻性双中心研究设计，在接受机械通气的COVID-19患者中，当动脉血氧分压（P）/吸入氧分数（F）比值<200时采用PP。患者每次俯卧16小时。调整压力水平F，以确保P大于60 mmHg。在俯卧位之前（基线0.5小时）、期间（1/2/5.5/9.5/13小时）和之后（1小时）进行血气分析，持续监测循环/通气参数，并大致计算肺顺应性（LC）。与基线值相比定义反应者（P/F比值增加≥15%；二氧化碳分压（P）降低≥2%）。
纳入13例患者，进行了36次PP治疗。总体而言，俯卧位时P/F显著增加（<0.001）。大多数P/F反应者（29/36次PP治疗，77%）在俯卧9.5小时后被识别（14%为慢反应者），而大多数P反应者（15/36次PP治疗，42%）在俯卧13小时后被识别。一组患者（气管插管至PP间隔≥3天）显示P/F反应者较少（16%对77%）。俯卧位时P和分钟通气量的增加呈显著负相关（<0.001）。LC（俯卧位前中位数=38 mL/cm H₂O；两名患者LC>80 mL/cm H₂O）与患者28天生存率呈显著正相关（=0.01）。
PP显著改善COVID-19 ARDS患者的氧合。数据表明，他们也最能从早期PP中获益。分钟通气量的减少可能导致P反应者减少。LC可能是COVID-19患者的一个预测结果参数。
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