1 research outputs found
Awake prone position reduces work of breathing in patients with COVID-19 ARDS supported by CPAP
Background
The use of awake prone position concomitant to non-invasive mechanical ventilation in acute respiratory distress syndrome (ARDS) secondary to COVID-19 has shown to improve gas exchange, whereas its effect on the work of breathing remain unclear. The objective of this study was to evaluate the effects of awake prone position during helmet continuous positive airway pressure (CPAP) ventilation on inspiratory effort, gas exchange and comfort of breathing.
Methods
Forty consecutive patients presenting with ARDS due to COVID-19 were prospectively enrolled. Gas exchange, esophageal pressure swing (ΞPes), dynamic transpulmonary pressure (dTPP), modified pressure time product (mPTP), work of breathing (WOB) and comfort of breathing, were recorded on supine position and after 3 h on prone position.
Results
The median applied PEEP with helmet CPAP was 10 [8β10] cmH2O. The PaO2/FiO2 was higher in prone compared to supine position (Supine: 166 [136β224] mmHg, Prone: 314 [232β398] mmHg, pβ<β0.001). Respiratory rate and minute ventilation decreased from supine to prone position from 20 [17β24] to 17 [15β19] b/min (pβ<β0.001) and from 8.6 [7.3β10.6] to 7.7 [6.6β8.6] L/min (pβ<β0.001), respectively. Prone position did not reduce ΞPes (Supine: β 7 [β 9 to β 5] cmH2O, Prone: β 6 [β 9 to β 5] cmH2O, pβ=β0.31) and dTPP (Supine: 17 [14β19] cmH2O, Prone: 16 [14β18] cmH2O, pβ=β0.34). Conversely, mPTP and WOB decreased from 152 [104β197] to 118 [90β150] cmH2O/min (pβ<β0.001) and from 146 [120β185] to 114 [95β151] cmH2O L/min (pβ<β0.001), respectively. Twenty-six (65%) patients experienced a reduction in WOB of more than 10%. The overall sensation of dyspnea was lower in prone position (pβ=β0.005).
Conclusions
Awake prone position with helmet CPAP enables a reduction in the work of breathing and an improvement in oxygenation in COVID-19-associated ARDS