一次体位摆放对清醒未插管的COVID-19肺炎患者的影响：一项使用肺部超声的多中心、观察性试点研究
Effects of a Chair Positioning Session on Awake Non-Intubated COVID-19 Pneumonia Patients: A Multicenter, Observational, and Pilot Study Using Lung Ultrasound.
作者信息
Lopez Alexandre, Simeone Pierre, Delamarre Louis, Duclos Gary, Arbelot Charlotte, Lakbar Ines, Pastene Bruno, Bezulier Karine, Dahan Samuel, Joffredo Emilie, Jay Lucille, Velly Lionel, Allaouchiche Bernard, Hraiech Sami, Leone Marc, Zieleskiewicz Laurent
机构信息
Department of Anesthesiology and Intensive Care, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, 13015 Marseille, France.
Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, 13015 Marseille, France.
出版信息
J Clin Med. 2022 Oct 5;11(19):5885. doi: 10.3390/jcm11195885.
BACKGROUND
LUS is a validated tool for the management of COVID-19 pneumonia. Chair positioning (CP) may have beneficial effects on oxygenation and lung aeration, and may be an easier alternative to PP. This study assessed the effects of a CP session on oxygenation and lung aeration (LA) changes in non-intubated COVID-19 patients.
METHODS
A retrospective multicenter study was conducted in an ICU. We analyzed data from LUS exams and SpO:FiO performed before/after a CP session in non-intubated COVID-19 patients. Patients were divided into groups of responders or non-responders in terms of oxygenation or LA.
RESULTS
Thirty-three patients were included in the study; fourteen (44%) were oxygenation non-responders and eighteen (56%) were oxygenation responders, while thirteen (40.6%) and nineteen (59.4%) patients were classified as LA non-responders and responders, respectively. Changes in oxygenation and LA before/after a CP session were not correlated (r = -0.19, = 0.3, 95% CI: -0.5-0.17). The reaeration scores did not differ between oxygenation responders and non-responders (1 (-0.75-3.75) vs. 4 (-1-6), = 0.41). The LUS score was significantly correlated with SpO:FiO before a CP session (r = 0.37, = 0.04, 95% CI: 0.03-0.64) but not after (r = 0.17, = 0.35, 95% CI: -0.19-0.50).
CONCLUSION
A CP session was associated with improved oxygenation and LA in more than half of the non-intubated COVID-19 patients.
背景
肺部超声（LUS）是一种经过验证的用于管理新型冠状病毒肺炎（COVID-19肺炎）的工具。体位摆放（CP）可能对氧合和肺通气有有益影响，并且可能是俯卧位通气（PP）的一种更简便替代方法。本研究评估了一次CP对非插管COVID-19患者氧合和肺通气（LA）变化的影响。
方法
在一家重症监护病房（ICU）进行了一项回顾性多中心研究。我们分析了非插管COVID-19患者在一次CP前后进行的LUS检查和动脉血氧饱和度/吸入氧浓度（SpO₂/FiO₂）数据。根据氧合或LA情况将患者分为反应者组或无反应者组。
结果
33例患者纳入研究；14例（44%）为氧合无反应者，18例（56%）为氧合反应者，而13例（40.6%）和19例（59.4%）患者分别被分类为LA无反应者和反应者。一次CP前后的氧合和LA变化无相关性（r = -0.19，P = 0.3，95%置信区间：-0.5 - 0.17）。氧合反应者和无反应者之间的再通气评分无差异（1（-0.75 - 3.75）对4（-1 - 6），P = 0.41）。CP前LUS评分与SpO₂/FiO₂显著相关（r = 0.37，P = 0.04，95%置信区间：0.03 - 0.64），但CP后无相关性（r = 0.17，P = 0.35，95%置信区间：-0.19 - 0.50）。
结论
在超过一半的非插管COVID-19患者中，一次CP与氧合和LA改善相关。
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