Effect of Trendelenburg position during prone ventilation in fifteen COVID-19 patients. Observational study

Su, Marissa; Yamasaki, Kimiyo; Daoud, Ehab

doi:10.53097/jmv.10035

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…29,30 A recent observational study by our group in COVID-19 proned patients showed that when placing the patient in the trendelenburg position, the tidal volume and the respiratory compliance markedly improved. 31 Regarding the perceived benefits of the prone position for the COVID-19 patients, our results again showed no statistically significant agreement with a majority of those surveyed (45%) who claimed the maneuver is beneficial in 25%-50% of cases but wide variety of perception from the extremes of no benefits or highly beneficial in more than 75% of the cases. Those results reflect the current literature of unknown mortality benefits for COVID-19 patients.…”

Section: Discussioncontrasting

confidence: 77%

Application of the prone position during COVID-19 pandemic. (PROCOV). An international survey of clinicians

Benavente¹,

Yoshimura²,

Davis³

et al. 2022

JMV

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Background Benefits of the prone position in ARDS are well established, and the evidence of its benefits for the COVID-19 patients are growing. However, the clinical utilization of such a maneuver is less established. We attempted to analyze the clinician’s utilization and attitude of the prone position and what is the main drive for its usage. Methods An international survey of eight questions. The questionnaire was anonymous and included the country of practice, percentage of patients with COVID-19 they have placed in the prone position while undergoing mechanical ventilation, most important factor that determined the need for the prone position (SpO2, PaO2:FiO2, FIO2, PEEP), duration of prone position in hours/day, use of neuro-muscular blocking agents, body position (flat, trendelenburg, reverse trendelenburg), the use of a specific protocol for the prone position, if they believe that prone position is beneficial, and if their practice will change or not. The survey was active for five months. Statistical analysis included frequencies of each response, as well as subgroup analyses designed to identify potential correlates of longer or shorter proning durations. The questionnaire assessed clinicians optimism regarding the continuing use of proning in the future, and how different cutoffs for proning initiation may be associated with attitudes towards proning. Associations between categorical variables were analyzed using Fisher’s exact test. A P-value of < 0.05 was considered statistically significant. Results are expressed in Means ± Standard Deviation (SD) Results 294 questionnaires were collected from 35 countries with 78% of responders from the USA. Median duration of proning was 14.8 ± 2.8 hours per day. 74% of clinicians utilized an established protocol for proning their patients. The decision to initiate proning was non-significant and split between the use of oxygen saturation SpO2 (30%) mean 92.44 ± 5.61, PaO2:FiO2 ratio (28%) mean 188.44 ± 57.36, FiO2 mean 78.6 ± 15.65, PEEP mean 12.96 ± 4.66, or immediate prone positioning following intubation (22%). 41.2% of surveyed utilize the prone position in 25-50%, average percent patients proned calculated at 7.1%. Estimated 77% of respondents reported prone positioning to be helpful in 50% or less of cases. 91% of responders used NMB either always or frequently, and there was statistical significance between the use of NMB and perceived benefits of proning (P < 0.001). 74% of those surveyed use a protocol for proning, the use of protocol and the perceived benefits of proning was statistically significant (P <0.001). Conclusion There are few agreements between clinicians on the duration of the proning sessions and use of NMB and using a protocol for proning. There was no agreement on the trigger of the prone position or the belief of its usefulness. This ambiguity should trigger an evidence-based ARDS management using the prone position in COVID-19 patients.

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Section: Discussioncontrasting

confidence: 77%

Application of the prone position during COVID-19 pandemic. (PROCOV). An international survey of clinicians

Benavente¹,

Yoshimura²,

Davis³

et al. 2022

JMV

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“…The Trendelenberg position during the proning position is more optimal than the flat position with the head turned to the right or left because the Trendelenberg position increases tidal volume and lung compliance. (Kodamanchili et al, 2022;Su et al, 2021). Image 3.…”

Section: Image 1 Precise Size Of Proning Mattressmentioning

confidence: 99%

Design of a Proning Mattress to Increase Oxygen Saturation in Patients with Respiratory Problems

Rosida,

Fitriahadi,

Ariyanto

et al. 2023

Kemas

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Posisi pronasi yang tepat terbukti dapat meningkatkan saturasi oksigen pada pasien dengan gangguan pernafasan, namun demikian masih muncul banyak kebingungan dikarenakan pengaturan posisi pronasi hanya dianjurkan dengan menggunakan penyangga bantal di beberapa titik tubuh pasien. Perbedaan ukuran bantal sangat dimungkinkan terjadi pada setiap pengaturan posisi di tempat yang berbeda, sehingga diperlukan alat pengatur posisi pronasi yang sudah presisi, aman, nyaman dan dapat langsung digunakan oleh pasien dengan keluhan sesak nafas. Tujuan dari penelitian ini adalah membuat dan mengembangkan prototipe “marning” (matras proning) untuk mempermudah melakukan posisi pronasi dalam upaya meningkatkan saturasi Oksigen pada pasien dengan keluhan sesak nafas. Metode penelitian dilakukan dengan membuat Matras proning yang didesain dengan mempertimbangkan bentuk anatomi dan ergonomi tubuh, sehingga sudah sangat presisi dalam meningkatkan saturasi oksigen. Uji presisi dan ergonomi tubuh untuk pembuatan dan penentuan ukuran matras dilakukan melalui pengukuran terhadap 20 responden dengan berbagai macam postur baik laki laki maupun perempuan. Pengukuran dilakukan di laboratorium klinik fisioterapi. Setelah itu hasil prototipe matras diuji efektifitasnya pada pasien sesak nafas untuk melihat peningkatan saturasi oksigen sebelum dan sesudah menggunakan matras proning. Uji efektifitas dilakukan di Poli Infeksi Puskesmas pathuk 1 Gunungkidul Yogyakarta sebagai mitra pada penelitian ini. Model teknologi ini sudah berhasil dibuat prototipenya dan telah diujicobakan pada 8 responden dengan keluhan sesak nafas, hasilnya terjadi peningkatan saturasi oksigen pada 80% pasien dengan keluhan sesak nafas (saturasi dibawah 95%). Matras ini didesain untuk menggantikan penggunaan bantal pada pengaturan posisi proning yang umum. Desain marning yang mempertimbangkan bentuk anatomi dan ergonomi tubuh menghasilkan ukuran yang presisi sehingga mencegah bantal bergeser. Inovasi ini memungkinkan pasien melakukan posisi proning yang tepat, nyaman dan juga sangat efektif dan efisien karena dapat langsung digunakan secara mandiri, namun demikian alat yang dikembangkan perlu penyempurnaan pada riset berikutnya, untuk mendapatkan alat yang lebih ringan sehingga mudah untuk dipindahkan dan dibawa kemana saja.

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Effects of the prone position on gas exchange and ventilatory mechanics and their correlations with mechanical power in burn patients with ARDS

Franck,

Daoud

2024

JMV

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Background Prone position has many documented benefits on severe ARDS patients especially on mortality. The benefits in ARDS secondary to severe burns have not been fully documented. Aim To quantify the effects of prone positioning on gas exchange, ventilatory mechanics and their correlations with mechanical power in burn subjects with ARDS. Methods Cross-sectional observational analytical study that took place between January 2023 and October 2023 in Burns ICU in Brazil on subjects with moderate to severe ARDS ventilated with the volume controlled mode. Data were collected in the first prone positioning lasting 24 hours in the first 30 minutes after changing position and 30 minutes before returning to the supine position. The parameters of the components of mechanical ventilation and mechanical power calculated by the Gatinoni’s formula (respiratory rate, tidal volume, driving pressure, PEEP, peak and plateau pressures) were collected to evaluate ventilatory mechanics, and the values of the FiO2, PaO2, PaO2/FiO2 ratio, SpO2, EtCO2, PaCO2, PaCO2 - EtCO2 gradient to assess gas exchange. Mean, minimum and maximum values, 1st and 3rd quartiles, median and standard deviation are calculated. To compare the results obtained at the two evaluation moments, the student’s t-test for dependent samples and non-parametric Wilcoxon tests were considered. To evaluate the association between the variation between the two moments of each variable, and the variation in mechanical power, the Pearson correlation coefficient was calculated. The normality of the variables was assessed using the Jarque-Béra test. P values <0.05 indicated statistical significance. Results Except for EtCO2 (P 0.939) and PaCO2 (P 0.391) all other variables presented statistical significance in relation to their variations with reduction in FiO2 (P <0.001), reduction in PaCO2 - EtCO2 gradient (P 0.011), and increases in PaO2 (P 0.008), PaO2/FiO2 (P <0.001), SpO2 (P 0.004). In the analysis of variables, reduction in respiratory rate (P 0.142), VT (P 0.385), peak pressure (P 0.085), plateau pressure (P 0.009), PEEP (P 0.032), driving pressure (P 0.083), elastance (P 0.180), mechanical power (P < 0.001) with increase static compliance (P 0.414) and resistance pressure (P 0.443). Among the ventilatory mechanics variables, only the reductions in plateau pressure, PEEP, and mechanical power showed statistical significance. Conclusion The prone position in burns induced ARDS improved oxygenation and reduced arterial partial pressure to end tidal CO2 gradient, furthermore, reducing plateau pressures and PEEP, which in turn reduced mechanical power. Keywords: mechanical power, burns, ARDS, prone position

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Effect of Trendelenburg position during prone ventilation in fifteen COVID-19 patients. Observational study

Cited by 3 publications

References 16 publications

Application of the prone position during COVID-19 pandemic. (PROCOV). An international survey of clinicians

Application of the prone position during COVID-19 pandemic. (PROCOV). An international survey of clinicians

Design of a Proning Mattress to Increase Oxygen Saturation in Patients with Respiratory Problems

Effects of the prone position on gas exchange and ventilatory mechanics and their correlations with mechanical power in burn patients with ARDS

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