Increased lung recruitability seen with alternating body position between supine and prone positioning
THURSDAY, March 26, 2020 (HealthDay News) — Lung recruitability can be assessed at bedside in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)-induced acute respiratory distress syndrome (ARDS), and alternating body positioning can improve recruitability, according to a study published online March 23 in the American Journal of Respiratory and Critical Care Medicine.
Chun Pan, M.D., from Southeast University in Nanjing, China, and colleagues describe their use of the recruitment-to-inflation ratio (R/I ratio) in a series of mechanically ventilated patients with SARS-CoV-2-associated ARDS and the effect produced by body positioning. The R/I ratio estimates how much of an increase in end-expiratory lung volume induced by positive end-expiratory pressure (PEEP) is distributed between the recruited lung and the inflation and/or hyperinflation of the baby lung when a higher PEEP is applied. A total of 12 patients were enrolled; seven patients received at least one session of prone positioning during the six-day observation period.
The researchers found that on the first day of observation, 10 of the 12 patients were poorly recruitable (R/I ratio, 0.21 ± 0.14). Persistent poor recruitability was seen for patients who did not receive prone positioning (one of 17 daily measurements showed high recruitability). Alternating body position between supine and prone positioning was associated with increased lung recruitability (13 of 36 daily measurements showed high recruitability). The ratio of arterial oxygen partial pressure to fractional inspired oxygen went from 120 ± 61 mm Hg to 182 ± 140 mm Hg at supine and prone, respectively, in patients who were placed in the prone position.
“We think these findings might incite clinicians to assess respiratory mechanics and lung recruitability in this population,” the authors write.
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