COVID-19 急性呼吸衰竭清醒俯卧位的血液动力学效应。
Hemodynamic Effects of Awake Prone Positioning With COVID-19 Acute Respiratory Failure.
机构信息
Service d'anesthésie-réanimation, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Bron, France; Faculté de médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France; and CarMeN Laboratory, Inserm UMR 1060, Université Claude Bernard Lyon 1, Lyon, France.
Service d'anesthésie-réanimation, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Bron, France; and Faculté de médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France.
出版信息
Respir Care. 2023 Jun;68(6):713-720. doi: 10.4187/respcare.10597.
INTRODUCTION
Awake prone positioning (PP) reduces need for intubation for patients with COVID-19 with acute respiratory failure. We investigated the hemodynamic effects of awake PP in non-ventilated subjects with COVID-19 acute respiratory failure.
METHODS
We conducted a single-center prospective cohort study. Adult hypoxemic subjects with COVID-19 not requiring invasive mechanical ventilation receiving at least one PP session were included. Hemodynamic assessment was done with transthoracic echocardiography before, during, and after a PP session.
RESULTS
Twenty-six subjects were included. We observed a significant and reversible increase in cardiac index (CI) during PP compared to supine position (SP): 3.0 ± 0.8 L/min/m in PP, 2.5 ± 0.6 L/min/m before PP (SP1), and 2.6 ± 0.5 L/min/m after PP (SP2 < .001). A significant improvement in right ventricular (RV) systolic function was also evidenced during PP: The RV fractional area change was 36 ± 10% in SP1, 46 ± 10% during PP, and 35 ± 8% in SP2 ( < .001). There was no significant difference in P /F and breathing frequency.
CONCLUSION
CI and RV systolic function are improved by awake PP in non-ventilated subjects with COVID-19 with acute respiratory failure.
简介
清醒俯卧位（PP）可降低 COVID-19 急性呼吸衰竭患者需要插管的概率。我们研究了清醒 PP 对非机械通气 COVID-19 急性呼吸衰竭患者的血流动力学影响。
方法
我们进行了一项单中心前瞻性队列研究。纳入了需要接受至少一次 PP 治疗的非机械通气 COVID-19 低氧血症患者。在 PP 治疗前后使用经胸超声心动图进行血流动力学评估。
结果
共纳入 26 例患者。与仰卧位（SP）相比，PP 期间的心脏指数（CI）显著增加且可恢复：PP 时为 3.0 ± 0.8 L/min/m，PP 前为 2.5 ± 0.6 L/min/m（SP1），PP 后为 2.6 ± 0.5 L/min/m（SP2 <.001）。在 PP 期间还证实了右心室（RV）收缩功能的显著改善：SP1 时 RV 收缩分数变化为 36 ± 10%，PP 时为 46 ± 10%，SP2 时为 35 ± 8%（ <.001）。P/F 和呼吸频率没有显著差异。
结论
在非机械通气 COVID-19 急性呼吸衰竭患者中，清醒 PP 可改善 CI 和 RV 收缩功能。
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