Prone Positioning and Regional Ventilation in Mechanically Ventilated COVID-19 Patients

NCT ID: NCT04359407

Last Updated: 2021-07-21

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 29 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2020-04-27
• Study Completion Date: 2021-05-10

Brief Summary

The consensus therapeutic strategy implies that COVID patients with acute lung injury due to coronavirus are routinely placed in prone position in an attempt to improve oxygenation by increasing ventilation homogeneity. The purpose of the study is to quantify with the electrical impedance tomography (EIT) the changes in the ventilation and aeration in the dorsal regions of the lung when the patient is placed in prone position.

Detailed Description

Patients with acute respiratory distress syndrome (ARDS) frequently develop atelectasis in dorsal lung regions because of gravity and the compression by the heart and the diaphragm. Since lung perfusion is predominantly distributed in lower lung regions, a reduction of ventilation in these areas results in further ventilation-perfusion mismatch, called shunt. The development of atelectatic lung regions necessitate the use of higher ventilation pressures, which in turn results in excessive transpulmonary pressures and ventilation-induced lung injury in the ventral regions. Therefore it is common to promote the prone position in patients with ARDS in order to improve ventilation-perfusion matching and thus, protect the ventral regions from hyperinflation. In patients with COVID-19-related ARDS, the value of such therapeutic strategy based on placing in prone position has not been completely elucidated. The aims of the study are to determine whether prone positioning improves dorsal regional ventilation when compared to supine position. Moreover, another aim is to assess the changes in intrapulmonary shunt following patient position changes.

Conditions

Severe Acute Respiratory Syndrome Coronavirus 2; Electric Impedance; Prone Positioning

Study Design

• Observational Model Type: CASE_ONLY
• Study Time Perspective: PROSPECTIVE

Interventions

Prone positioning

Change the positioning of the COVID patients who are intubated and mechanically ventilated from supine to prone

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

Patients fulfilling all the following criteria are eligible for the study:

• Mechanically ventilated
• Fit the Berlin Definition for moderate or severe acute respiratory distress syndrome (arterial oxygen partial pressure over inspiratory fraction of oxygen less than 200 mmHg)
• Infection with coronavirus confirmed
• Scheduled to undergo prone positioning

Exclusion Criteria

• Patients with pacemakers, defibrillators or other electrically active implants
• Patients with damaged skin or impaired skin contact of the electrodes due to wound dressings
• Patients with chest tubes
• History of thoracic surgery or lung resection

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Walid HABRE

OTHER

Sponsor Role: lead

Responsible Party

Walid HABRE

Professor

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Walid Habre, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Geneva

Locations

University Hospitals of Geneva

Geneva, , Switzerland

Countries

Switzerland

References

Dos Santos Rocha A, Diaper J, Balogh AL, Marti C, Grosgurin O, Habre W, Petak F, Sudy R. Effect of body position on the redistribution of regional lung aeration during invasive and non-invasive ventilation of COVID-19 patients. Sci Rep. 2022 Jun 30;12(1):11085. doi: 10.1038/s41598-022-15122-9.

Reference Type: DERIVED

PMID: 35773299 (View on PubMed)

Other Identifiers

2020-00896

Identifier Type: -

Identifier Source: org_study_id