https://doi.org/10.4081/amsa.2023.9

Efficacy of repeated pronations in patients affected by COVID-19-related acute respiratory distress syndrome: think it twice!

Vol. 1 No. 1 (2023)
Submitted: 3 March 2023
Accepted: 24 March 2023
Published: 28 April 2023
COVID-19, pronation, pulmonary shunt, ventilation/perfusion mismatch, ARDS, CARDS
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Authors

Andrea Sica
andrea.sica@auslromagna.it
Anesthesia and Intensive Care Unit, Bufalini Hospital, Cesena, Italy.
Luca Gobbi
Anesthesia and Intensive Care Unit, Bufalini Hospital, Cesena, Italy.
Daniele Bellantonio
Anesthesia and Intensive Care Unit, Bufalini Hospital, Cesena, Italy.
Silvia Passero
Anesthesia and Intensive Care Unit, Bufalini Hospital, Cesena, Italy.
Lorenzo Viola
Anesthesia and Intensive Care Unit, Bufalini Hospital, Cesena, Italy.

Prone position is widely used to ameliorate gas exchange in severe COVID-19-related ARDS (CARDS), through its beneficial effects on shunt and dead space. However, the effectiveness of repeated pronation has never been explored in this category of patients. We then retrospectively analyzed the changes of the alveolar-arterial oxygen gradient (A-aO2grad), as shunt index, and the ratio EtCO2/paCO2 ratio, as dead space index, during repeated pronation cycles in 7 patients with CARDS admitted to our Intensive Care Unit. The A-aO2grad decreased significantly more during the first pronation than the second (-43.6% vs -12.2% - p0.008) and, similarly, the improvement was maintained only after the first supination (-26.2% vs +9% - p0.04). The EtCO2/paCO2 ratio showed similar behavior but did not achieve statistical significance. Considering our findings, with the inherent limitations of the study, since pronation entails risks for the patient, as well as requiring a lot of effort from the nursing staff, further caution appears to be necessary in indicating pronation.

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Gattinoni L, Busana M, Giosa L, et al. Prone positioning in Acute Respiratory Distress Syndrome. Semin Respir Crit Care Med 2019:40:94-100. DOI: https://doi.org/10.1055/s-0039-1685180
Abroug F, Ouanes-Besbes L, Elatrous S, et al. The effect of prone positioning in acute respiratory distress syndrome or acute lung injury: a meta-analysis: areas of uncertainty and recommendations for research. Intensive Care Med 2008;34:1002–11. DOI: https://doi.org/10.1007/s00134-008-1062-3
Sud S, Friedrich JO, Adhikari NK, et al. Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ 2014;186:E381–E390. DOI: https://doi.org/10.1503/cmaj.140081
Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368:2159–68. DOI: https://doi.org/10.1056/NEJMoa1214103
Petrucci N, De Feo C. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev 2013;2:CD003844. DOI: https://doi.org/10.1002/14651858.CD003844.pub4
Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med 2017;195:438–442. DOI: https://doi.org/10.1164/rccm.201605-1081CP
Qadri SK, Ng P, Toh TSW, et al. Critically ill patients with COVID-19: a narrative review on prone position. Pulm Ther 2020:6:233-46. DOI: https://doi.org/10.1007/s41030-020-00135-4
Scaramuzzo G, Gamberini L, Tonetti T, et al. Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study. Ann Intensive Care 2021:11:63. DOI: https://doi.org/10.1186/s13613-021-00853-1
Bussani R, Schneider E, Zentilin L, Persistence of viral RNA, pneumocyte syncytia and thrombosis are hallmarks of advanced COVID-19 pathology. E Bio Medicine 2020:61:103-4. DOI: https://doi.org/10.1016/j.ebiom.2020.103104
Gattinoni L, Chiumello D, Rossi S. COVID-19 pneumonia: ARDS or not? Crit Care 2020:24:154. DOI: https://doi.org/10.1186/s13054-020-02880-z
Harris DE, Massie M. Role of alveolar-arterial gradient in partial pressure of oxygen and PaO2/fraction of inspired oxygen ratio measurements in assessment of pulmonary dysfunction. AANA J 2019:87:214-21.

How to Cite

Sica, A., Gobbi, L., Bellantonio, D., Passero, S., & Viola, L. (2023). Efficacy of repeated pronations in patients affected by COVID-19-related acute respiratory distress syndrome: think it twice!. Acute Care Medicine Surgery and Anesthesia, 1(1). https://doi.org/10.4081/amsa.2023.9
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