Awake prone positioning and ventilation distribution as assessed by electric impedance tomography in patients with non-COVID-19 acute hypoxemic respiratory failure:A prospective physiology study  

作　　者：Jingjing Wang Changxing Chen Zhanqi Zhao Puyu Deng Chenchen Zhang Yu Zhang Hui Lv Daonan Chen Hui Xie Ruilan Wang 

机构地区：[1]Critical Care Medicine,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,China [2]Institute of Technical Medicine,Furtwangen University,Villingen-Schwenningen,Germany

出　　处：《Journal of Intensive Medicine》2025年第1期43-50,共8页重症医学(英文)

基　　金：supported by National Clinical Key Specialty(grant number:Z155080000004));Clinical management optimization project of SHDC(grant number:SHDC22022206).

摘　　要：Background:Awake prone positioning(APP)can reportedly reduce the need for intubation and help improve prognosis of patients with acute hypoxemic respiratory failure(AHRF)infected with COVID-19.However,its physiological mechanism remains unclear.In this study,we evaluated the effect of APP on lung ventilation in patients with moderate-to-severe AHRF to better understand the effects on ventilation distribution and to prevent intubation in non-intubated patients.Methods:The prospective study was performed in the Department of Critical Care Medicine at Shanghai General Hospital,China,from January 2021 to November 2022.The study included patients with AHRF(partial pressure of oxygen[PaO_(2)]/inspired oxygen concentration[FiO_(2)]<200 mmHg or oxygen saturation[SpO_(2)]/FiO_(2)<235]treated with high-flow nasal oxygen.Electrical impedance tomography(EIT)measurements including center of ventilation(COV),global inhomogeneity(GI)index,and regional ventilation delay(RVD)index were performed in the supine position(To),30 min after the start of APP(Ti),and 30 min returning to supine position after the APP(T2).Clinical parameters like SpO_(2),respiratory rate(RR),FiO_(2),heart rate(HR),and ROX(the ratio of SpO_(2) as measured by pulse oximetry/FiO_(2) to RR)were also recorded simultaneously at To,Ti,and T2.To evaluate the effect of the time points on the variables,Mauchly's test was performed for sphericity and repeated measures analysis of variance was applied with Bonferroni's post hoc multiple comparisons.Results:Ten patients were enrolled.The Pa02/FiO_(2) ratio was(111.4±33.4)mmHg at the time of recruitment.ROX showed a significant increase after initiation of APP(median(interquartile range[IQR)):To:7.5(6.0-10.1)vs.Ti:7.6(6.4-9.3)vs.T2:8.3(7.2-11.0),P=0.043).RR(P=0.409),HR(P=0.417),and SpO_(2)/FiO_(2)(P=0.262)did not change significantly during prone positioning(PP).The CoV moved from the ventral area to the dorsal area(To:48.8%±6.2%vs.T:54.8%±6.8%vs.T2:50.3%±6.1%,P=0.030)after APP.The GI decreased significantly after A

关 键 词：Acute hypoxemic respiratory failure Prone positions Electrical impedance tomography 

分 类 号：R73[医药卫生—肿瘤]