Cardiorespiratory Physiotherapy, Critical Care and Rehabilitation
https://cpcrjournal.org/article/doi/10.4322/2675-9977.cpcr.44141
Cardiorespiratory Physiotherapy, Critical Care and Rehabilitation
Original Research

Characterization of patients with COVID-19-related ARDS before the prone position: prospective cohort study

Giovani Bernardo Costa; Higor Apolinario Melquiades; Erich Vidal Carvalho; Edimar Pedrosa Gomes; Maycon Moura Reboredo; Bruno Valle Pinheiro

Downloads: 3
Views: 228

Abstract

Background: The general characteristics and ventilator-related variables of patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 infection who have undergone invasive mechanical ventilation (MV) remain unclear, especially those who need a prone position (PP). Aim: To characterize the clinical, demographical, and ventilatory variables of patients on MV with COVID-19-related ARDS, evolving to PP. Methods: This study was an observational prospective cohort investigation of COVID-19 patients undergoing invasive MV. PP and non-prone groups were compared using Student’s t, Mann-Whitney U, chi-square, or Fisher’s exact tests. Binary logistic regression was used to identify predictor variables. Statistical significance was set at p < 0.05. The study design was approved by the Research Ethics Committee. Results: The clinical and demographical characteristics of patients requiring PP were: age (63.4 ± 12.4 years), predicted body weight (57.3 ± 11.0 kg), SAPS 3 47.5 (41-55), SOFA 3 (2-6), comorbidities, days until intubation (1.2 ± 2.2 days), and death in the ICU (52.4%); these characteristics were similar to those who remained in supine position. A total of 42 (65.6%) subjects needed PP, especially females. There were no differences between PP and non-prone groups in respiratory system compliance (Crs) [(30.0 (24.6-35.3)], driving pressure (ΔP) (14.2 ± 3.9 cm H2O) and plateau pressure (Pplateau) (23.9 ± 4.7 cmH2O). The PP group had lower initial PaO2/FIO2 ratio values (130.5 ± 58.1 vs 187.5 ± 59.1, p < 0,05). Crs was not a significant predictor of PP (OR 1.702; CI 95% 0.962 – 1.131). Conclusions: Most patients required PP, especially females aged over 60. These patients frequently use neuromuscular blockers and had a longer hospital stay. Upon admission to the ICU, the Crs, Pplateau, and ΔP values of these patients were similar to those who did not require PP; PaO2/FiO2 ratio characterized patients who needed PP.

Keywords

COVID-19; SARS-CoV-2; Artificial Respiration; Prone Position; Respiratory Distress Syndrome.

References

1. She J, Jiang J, Ye L, Hu L, Bai C, Song Y. 2019 novel coronavirus of pneumonia in Wuhan, China: emerging attack and management strategies. Clin Transl Med. 2020;9(1):19. http://dx.doi.org/10.1186/s40169-020-00271-z. PMid:32078069.

2. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of Coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020;172(9):577-82. http://dx.doi.org/10.7326/M20-0504. PMid:32150748.

3. Camporota L, Chiumello D, Busana M, Gattinoni L, Marini JJ. Pathophysiology of COVID-19-associated acute respiratory distress syndrome. Lancet Respir Med. 2021 Jan;9(1):e1. http://dx.doi.org/10.1016/S2213-2600(20)30505-1. PMid:33197391.

4. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020 May 7;55(5):2000524. http://dx.doi.org/10.1183/13993003.00524-2020. PMid:32269088.

5. Botta M, Tsonas AM, Pillay J, Boers LS, Algera AG, Bos LDJ, et al. Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study. Lancet Respir Med. 2021 Feb;9(2):139-48. http://dx.doi.org/10.1016/S2213-2600(20)30459-8. PMid:33169671.

6. Mittermaier M, Pickerodt P, Kurth F, de Jarcy LB, Uhrig A, Garcia C, et al. Evaluation of PEEP and prone positioning in early COVID-19 ARDS. EClinicalMedicine. 2020 Nov;28:100579. http://dx.doi.org/10.1016/j.eclinm.2020.100579. PMid:33073217.

7. Tsolaki V, Zakynthinos GE, Makris D. The ARDSnet protocol may be detrimental in COVID-19. Crit Care. 2020 Jun 16;24(1):351. http://dx.doi.org/10.1186/s13054-020-03081-4. PMid:32546230.

8. Goligher EC, Ranieri VM, Slutsky AS. Is severe COVID-19 pneumonia a typical or atypical form of ARDS? And does it matter? Intensive Care Med. 2021 Jan;47(1):83-5. http://dx.doi.org/10.1007/s00134-020-06320-y. PMid:33237346.

9. Gibson PG, Qin L, Puah SH. COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS. Med J Aust. 2020 Jul;213(2):54-56.e1. http://dx.doi.org/10.5694/mja2.50674. PMid:32572965.

10. Langer T, Brioni M, Guzzardella A, Carlesso E, Cabrini L, Castelli G, et al. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients. Crit Care. 2021 Apr 6;25(1):128. http://dx.doi.org/10.1186/s13054-021-03552-2. PMid:33823862.

11. Krause M, Douin DJ, Kim KK, Fernandez-Bustamante A, Bartels K. Characteristics and Outcomes of Mechanically Ventilated COVID-19 Patients-An Observational Cohort Study. J Intensive Care Med. 2021 Mar;36(3):271-6. http://dx.doi.org/10.1177/0885066620954806. PMid:32873103.

12. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526-33. http://dx.doi.org/10.1001/jama.2012.5669. PMid:22797452.

13. Ranzani OT, Bastos LSL, Gelli JGM, Marchesi JF, Baião F, Hamacher S, et al. Characterisation of the first 250,000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data. Lancet Respir Med. 2021 Apr;9(4):407-18. http://dx.doi.org/10.1016/S2213-2600(20)30560-9. PMid:33460571.

14. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun 6;368(23):2159-68. http://dx.doi.org/10.1056/NEJMoa1214103. PMid:23688302.

15. Cao Z, Yang Z, Liang Z, Cen Q, Zhang Z, Liang H, et al. Prone versus supine position ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. Emerg Med Int. 2020 Nov 30;2020:4973878. http://dx.doi.org/10.1155/2020/4973878. PMid:33343939.

16. Gu Y, Wang D, Chen C, Lu W, Liu H, Lv T, et al. PaO2/FiO2 and IL-6 are risk factors of mortality for intensive care COVID-19 patients. Sci Rep. 2021 Apr 1;11(1):7334. http://dx.doi.org/10.1038/s41598-021-86676-3. PMid:33795768.

17. Lamm WJ, Graham MM, Albert RK. Mechanism by which the prone position improves oxygenation in acute lung injury. Am J Respir Crit Care Med. 1994 Jul;150(1):184-93. http://dx.doi.org/10.1164/ajrccm.150.1.8025748. PMid:8025748.

18. Gattinoni L, Taccone P, Carlesso E, Marini JJ. Prone position in acute respiratory distress syndrome. Rationale, indications, and limits. Am J Respir Crit Care Med. 2013 Dec 1;188(11):1286-93. http://dx.doi.org/10.1164/rccm.201308-1532CI. PMid:24134414.

19. Galiatsou E, Kostanti E, Svarna E, Kitsakos A, Koulouras V, Efremidis SC, et al. Prone position augments recruitment and prevents alveolar overinflation in acute lung injury. Am J Respir Crit Care Med. 2006 Jul 15;174(2):187-97. http://dx.doi.org/10.1164/rccm.200506-899OC. PMid:16645177.

20. Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med. 2020;2(8):1069-76. http://dx.doi.org/10.1007/s42399-020-00363-4. PMid:32838147.

21. Caruso FP, Scala G, Cerulo L, Ceccarelli M. A review of COVID-19 biomarkers and drug targets: resources and tools. Brief Bioinform. 2021 Mar 22;22(2):701-13. http://dx.doi.org/10.1093/bib/bbaa328. PMid:33279954.

22. Ferrando C, Suarez-Sipmann F, Mellado-Artigas R, Hernández M, Gea A, Arruti E, et al. Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med. 2020 Dec;46(12):2200-11.. http://dx.doi.org/10.1007/s00134-020-06192-2. PMid:32728965.

23. Ziehr DR, Alladina J, Petri CR, Maley JH, Moskowitz A, Medoff BD, et al. Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study. Am J Respir Crit Care Med. 2020 Jun 15;201(12):1560-4. http://dx.doi.org/10.1164/rccm.202004-1163LE. PMid:32348678.

24. Laverdure F, Delaporte A, Bouteau A, Genty T, Decailliot F, Stéphan F. Impact of initial respiratory compliance in ventilated patients with acute respiratory distress syndrome related to COVID-19. Crit Care. 2020 Jul 9;24(1):412. http://dx.doi.org/10.1186/s13054-020-03133-9. PMid:32646470.

25. Madotto F, Rezoagli E, Pham T, Schmidt M, McNicholas B, Protti A, et al. Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study. Crit Care. 2020 Mar 31;24(1):125. http://dx.doi.org/10.1186/s13054-020-2826-6. PMid:32234077.


Submitted date:
06/15/2021

Accepted date:
03/02/2022

62685a1ca9539511025b16f2 cpcr Articles
Links & Downloads

Cardiorespir Physiother Crit Care Rehabil

Share this page
Page Sections