Intensive Care Unit, Sainte Anne Military Teaching Hospital, Toulon, France.
Intensive Care Unit, Timone University Hospital, Marseille, France.
Crit Care Med. 2022 Jul 1;50(7):1093-1102. doi: 10.1097/CCM.0000000000005487. Epub 2022 Feb 11.
ICUs have had to deal with a large number of patients with acute respiratory distress syndrome COVID-19, a significant number of whom received prone ventilation, which is a substantial consumer of care time. The selection of patients that we have to ventilate in prone position seems interesting. We evaluate the correlation between the percentage of collapsed dependent lung areas in the supine position, monitoring by electrical impedance tomography and the oxygenation response (change in Pao2/Fio2 ratio) to prone position.
An observational prospective study.
From October 21, 2020, to 30 March 30, 2021. At the Sainte Anne military teaching Hospital and the Timone University Hospital.
Fifty consecutive patients admitted in our ICUs, with COVID-19 acute respiratory distress syndrome and required mechanical, were included. Twenty-four (48%) received prone ventilation. Fifty-eight prone sessions were investigated.
An electrical impedance tomography recording was made in supine position, daily and repeated just before and just after the prone session. The daily dependent area collapse was calculated in relation to the previous electrical impedance tomography recording. Prone ventilation response was defined as a Pao2/Fio2 ratio improvement greater than 20%.
The main outcome was the correlation between dependent area collapse and the oxygenation response to prone ventilation. Dependent area collapse was correlated with oxygenation response to prone ventilation (R2 = 0.49) and had a satisfactory prediction accuracy of prone response with an area under the curve of 0.94 (95% CI, 0.87-1.00; p < 0.001). Best Youden index was obtained for a dependent area collapse greater than 13.5 %. Sensitivity of 92% (95% CI, 78-97), a specificity of 91% (95% CI, 72-97), a positive predictive value of 94% (95% CI, 88-100), a negative predictive value of 87% (95% CI, 78-96), and a diagnostic accuracy of 91% (95% CI, 84-98).
Dependent lung areas collapse (> 13.5%), monitored by electrical impedance tomography, has an excellent positive predictive value (94%) of improved oxygenation during prone ventilation.
ICU 不得不应对大量患有 COVID-19 急性呼吸窘迫综合征的患者，其中很大一部分患者接受了俯卧位通气，这极大地消耗了护理时间。我们需要选择哪些患者进行俯卧位通气，这似乎很有趣。我们评估了仰卧位时依赖区塌陷肺的百分比、通过电阻抗断层成像监测以及对俯卧位的氧合反应（Pao2/Fio2 比值变化）之间的相关性。
一项观察性前瞻性研究。
2020 年 10 月 21 日至 2021 年 3 月 30 日，在 Sainte Anne 军事教学医院和 Timone 大学医院。
连续纳入我院 ICU 收治的 50 例 COVID-19 急性呼吸窘迫综合征患者，均需要机械通气。其中 24 例（48%）接受俯卧位通气。共研究了 58 次俯卧位通气。
仰卧位时进行电阻抗断层成像记录，每天进行，并在俯卧位前后重复进行。根据前一次电阻抗断层成像记录计算每日依赖区塌陷。俯卧位通气反应定义为 PaO2/FIO2 比值改善大于 20%。
主要结局是依赖区塌陷与俯卧位通气氧合反应之间的相关性。依赖区塌陷与俯卧位通气的氧合反应相关（R2=0.49），具有较好的预测准确性，曲线下面积为 0.94（95%CI，0.87-1.00；p<0.001）。最佳 Youden 指数为依赖区塌陷大于 13.5%。敏感性为 92%（95%CI，78-97），特异性为 91%（95%CI，72-97），阳性预测值为 94%（95%CI，88-100），阴性预测值为 87%（95%CI，78-96），诊断准确性为 91%（95%CI，84-98）。
电阻抗断层成像监测的依赖区塌陷（>13.5%）对俯卧位通气时氧合改善有极好的阳性预测值（94%）。
