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Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients

BACKGROUND: A sequential change in body position from supine-to-both lateral positions under constant ventilatory settings could be used as a postural recruitment maneuver in case of acute respiratory distress syndrome (ARDS), provided that sufficient positive end-expiratory pressure (PEEP) prevents...

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Autores principales: Roldán, Rollin, Rodriguez, Shalim, Barriga, Fernando, Tucci, Mauro, Victor, Marcus, Alcala, Glasiele, Villamonte, Renán, Suárez-Sipmann, Fernando, Amato, Marcelo, Brochard, Laurent, Tusman, Gerardo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8840950/
https://www.ncbi.nlm.nih.gov/pubmed/35150355
http://dx.doi.org/10.1186/s13613-022-00988-9
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author Roldán, Rollin
Rodriguez, Shalim
Barriga, Fernando
Tucci, Mauro
Victor, Marcus
Alcala, Glasiele
Villamonte, Renán
Suárez-Sipmann, Fernando
Amato, Marcelo
Brochard, Laurent
Tusman, Gerardo
author_facet Roldán, Rollin
Rodriguez, Shalim
Barriga, Fernando
Tucci, Mauro
Victor, Marcus
Alcala, Glasiele
Villamonte, Renán
Suárez-Sipmann, Fernando
Amato, Marcelo
Brochard, Laurent
Tusman, Gerardo
author_sort Roldán, Rollin
collection PubMed
description BACKGROUND: A sequential change in body position from supine-to-both lateral positions under constant ventilatory settings could be used as a postural recruitment maneuver in case of acute respiratory distress syndrome (ARDS), provided that sufficient positive end-expiratory pressure (PEEP) prevents derecruitment. This study aims to evaluate the feasibility and physiological effects of a sequential postural recruitment maneuver in early mechanically ventilated COVID-19 ARDS patients. METHODS: A cohort of 15 patients receiving lung-protective mechanical ventilation in volume-controlled with PEEP based on recruitability were prospectively enrolled and evaluated in five sequentially applied positions for 30 min each: Supine-baseline; Lateral-1st side; 2nd Supine; Lateral-2nd side; Supine-final. PEEP level was selected using the recruitment-to-inflation ratio (R/I ratio) based on which patients received PEEP 12 cmH(2)O for R/I ratio ≤ 0.5 or PEEP 15 cmH(2)O for R/I ratio > 0.5. At the end of each period, we measured respiratory mechanics, arterial blood gases, lung ultrasound aeration, end-expiratory lung impedance (EELI), and regional distribution of ventilation and perfusion using electric impedance tomography (EIT). RESULTS: Comparing supine baseline and final, respiratory compliance (29 ± 9 vs 32 ± 8 mL/cmH(2)O; p < 0.01) and PaO(2)/FIO(2) ratio (138 ± 36 vs 164 ± 46 mmHg; p < 0.01) increased, while driving pressure (13 ± 2 vs 11 ± 2 cmH(2)O; p < 0.01) and lung ultrasound consolidation score decreased [5 (4–5) vs 2 (1–4); p < 0.01]. EELI decreased ventrally (218 ± 205 mL; p < 0.01) and increased dorsally (192 ± 475 mL; p = 0.02), while regional compliance increased in both ventral (11.5 ± 0.7 vs 12.9 ± 0.8 mL/cmH(2)O; p < 0.01) and dorsal regions (17.1 ± 1.8 vs 18.8 ± 1.8 mL/cmH(2)O; p < 0.01). Dorsal distribution of perfusion increased (64.8 ± 7.3% vs 66.3 ± 7.2%; p = 0.01). CONCLUSIONS: Without increasing airway pressure, a sequential postural recruitment maneuver improves global and regional respiratory mechanics and gas exchange along with a redistribution of EELI from ventral to dorsal lung areas and less consolidation. Trial registration ClinicalTrials.gov, NCT04475068. Registered 17 July 2020, https://clinicaltrials.gov/ct2/show/NCT04475068 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-022-00988-9.
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spelling pubmed-88409502022-02-18 Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients Roldán, Rollin Rodriguez, Shalim Barriga, Fernando Tucci, Mauro Victor, Marcus Alcala, Glasiele Villamonte, Renán Suárez-Sipmann, Fernando Amato, Marcelo Brochard, Laurent Tusman, Gerardo Ann Intensive Care Research BACKGROUND: A sequential change in body position from supine-to-both lateral positions under constant ventilatory settings could be used as a postural recruitment maneuver in case of acute respiratory distress syndrome (ARDS), provided that sufficient positive end-expiratory pressure (PEEP) prevents derecruitment. This study aims to evaluate the feasibility and physiological effects of a sequential postural recruitment maneuver in early mechanically ventilated COVID-19 ARDS patients. METHODS: A cohort of 15 patients receiving lung-protective mechanical ventilation in volume-controlled with PEEP based on recruitability were prospectively enrolled and evaluated in five sequentially applied positions for 30 min each: Supine-baseline; Lateral-1st side; 2nd Supine; Lateral-2nd side; Supine-final. PEEP level was selected using the recruitment-to-inflation ratio (R/I ratio) based on which patients received PEEP 12 cmH(2)O for R/I ratio ≤ 0.5 or PEEP 15 cmH(2)O for R/I ratio > 0.5. At the end of each period, we measured respiratory mechanics, arterial blood gases, lung ultrasound aeration, end-expiratory lung impedance (EELI), and regional distribution of ventilation and perfusion using electric impedance tomography (EIT). RESULTS: Comparing supine baseline and final, respiratory compliance (29 ± 9 vs 32 ± 8 mL/cmH(2)O; p < 0.01) and PaO(2)/FIO(2) ratio (138 ± 36 vs 164 ± 46 mmHg; p < 0.01) increased, while driving pressure (13 ± 2 vs 11 ± 2 cmH(2)O; p < 0.01) and lung ultrasound consolidation score decreased [5 (4–5) vs 2 (1–4); p < 0.01]. EELI decreased ventrally (218 ± 205 mL; p < 0.01) and increased dorsally (192 ± 475 mL; p = 0.02), while regional compliance increased in both ventral (11.5 ± 0.7 vs 12.9 ± 0.8 mL/cmH(2)O; p < 0.01) and dorsal regions (17.1 ± 1.8 vs 18.8 ± 1.8 mL/cmH(2)O; p < 0.01). Dorsal distribution of perfusion increased (64.8 ± 7.3% vs 66.3 ± 7.2%; p = 0.01). CONCLUSIONS: Without increasing airway pressure, a sequential postural recruitment maneuver improves global and regional respiratory mechanics and gas exchange along with a redistribution of EELI from ventral to dorsal lung areas and less consolidation. Trial registration ClinicalTrials.gov, NCT04475068. Registered 17 July 2020, https://clinicaltrials.gov/ct2/show/NCT04475068 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-022-00988-9. Springer International Publishing 2022-02-12 /pmc/articles/PMC8840950/ /pubmed/35150355 http://dx.doi.org/10.1186/s13613-022-00988-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Roldán, Rollin
Rodriguez, Shalim
Barriga, Fernando
Tucci, Mauro
Victor, Marcus
Alcala, Glasiele
Villamonte, Renán
Suárez-Sipmann, Fernando
Amato, Marcelo
Brochard, Laurent
Tusman, Gerardo
Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients
title Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients
title_full Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients
title_fullStr Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients
title_full_unstemmed Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients
title_short Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients
title_sort sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated covid-19 ards patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8840950/
https://www.ncbi.nlm.nih.gov/pubmed/35150355
http://dx.doi.org/10.1186/s13613-022-00988-9
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