Computed tomography scanning in the prone position for a critically hypoxic patient with COVID‐19

Abstract

Prone positioning is an effective strategy to improve oxygenation in patients with coronavirus disease 2019 . In ventilated patients requiring computed tomography (CT) imaging, stable oxygenation is a prerequisite before transfer. Here, we present the thoracic CT scan of a ventilator-dependent 45-year-old man with COVID-19 undertaken in the prone position (Fig. 1). His oxygenation was stable (PaO 2 8-10 kPa on F I O 2 0.5-0.7) in the prone position, in which he spent much of the week before the scan, undertaken at day 19 of his critical care stay.The primary indication for imaging was to exclude undetected pathologies and assess suitability for high-dose steroid treatment. The risks and benefits of undertaking the scan were discussed over several days; the patient did not tolerate supine positioning for more than around 30 min, which was felt to represent an unacceptable risk in the CT suite environment. Transfer in the prone position is itself not without risk; however, a dedicated experienced team undertook the transfer having first planned the logistics with radiology colleagues. Viewing the tracheal tube and ventilator circuit throughout the range of travel in and out of the scanner was critical.Prone CT scans are undertaken in several conditions, notably in the awake patient when assessing interstitial lung disease [1]. With prone positon CT scans, non-fibrotic areas of lung will expand or be compressed with gravity and re-positioning. The same technique has been used to study reversibility in acute lung injury [2,3].With appropriate planning and execution, prone positioning for CT imaging is safe and feasible, and is an option for critically hypoxic patients.

Prone Chest Radiographs: Distinguishing Features and Identification of Support Devices

“…Trans-thoracic echocardiography has been studied more extensively, with a few small series establishing the feasibility of imaging prone COVID-19 patients [15][16][17]. Finally, case reports of COVID-19 patients have described use of prone chest CT [18,19] and improved ventilation-perfusion matching while prone using electric impedance tomography [20].…”

Case reports in the COVID‐19 pandemic: first responders to an emergency in evidence‐based medicine

“…The interplay between anaesthetists, intensivists and other specialties was demonstrated throughout the pandemic in the care of the most critically ill of these patients. McGrath et al discuss the risks involved in transferring a critically ill patient to the radiology department for computed tomography scanning in the prone position [18]. An appropriately experienced team undertook the transfer after having first planned the logistics with radiology colleagues, facilitating the successful completion of a potentially challenging transfer and procedure.…”

“…discuss the risks involved in transferring a critically ill patient to the radiology department for computed tomography scanning in the prone position [18]. An appropriately experienced team undertook the transfer after having first planned the logistics with radiology colleagues, facilitating the successful completion of a potentially challenging transfer and procedure.…”