Hypoxemia and prone position in mechanically ventilated Covid-19 patients: a prospective cohort study
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CORRESPONDENCE
Hypoxemia and prone position in mechanically ventilated Covid19 patients: a prospective cohort study Osama Abou-Arab, MD, PhD . Guillaume Haye, MD . Christophe Beyls, MD . Pierre Huette, MD . Pierre-Alexandre Roger, MD . Mathieu Guilbart, MD . Michae¨l Bernasinski, MD . Patricia Besserve, MD . Faouzi Trojette, MD . Herve´ Dupont, MD, PhD . Vincent Jounieaux, MD, PhD . Yazine Mahjoub, MD, PhD
Received: 8 July 2020 / Revised: 17 September 2020 / Accepted: 22 October 2020 Ó Canadian Anesthesiologists’ Society 2020
To the editor, During the COVID-19 outbreak, severe cases of COVID-19 related acute respiratory distress syndrome (ARDS) were admitted to our tertiary hospital ICU. The benefits of prone position (PP) on survival have been highlighted in previous ARDS studies.1 The aim of the study was to report the effects of PP in mechanically ventilated patients with COVID-19 related ARDS. Between March 1st and April 30th, we prospectively included all patients admitted to our ICU with COVID-19 related acute respiratory failure. COVID-19 was diagnosed by Rt-PCR on a nasopharyngeal swab. During this period, 70 patients with COVID-19 diagnosis were admitted; 64 (91%) received invasive mechanical ventilation during the course of the disease. They were ventilated with low tidal volume (B 6ml.kg-1), plateau pressure below 30 cmH2O, low driving pressure (B15 cmH2O) and PEEP according to the strategy proposed by the ARDS Network.2 Patients for whom PaO2/FiO2 ratio remained below 150 for 12 hours despite this protective ventilation, received at least one 16hour PP session (flow chart in Electronic supplementary Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01844-9) contains supplementary material, which is available to authorized users. O. Abou-Arab, MD, PhD G. Haye, MD C. Beyls, MD P. Huette, MD P.-A. Roger, MD M. Guilbart, MD M. Bernasinski, MD P. Besserve, MD F. Trojette, MD H. Dupont, MD, PhD Y. Mahjoub, MD, PhD (&) Department of Anesthesia and Critical Care Medicine, Amiens University Medical Center, Amiens, France e-mail: [email protected] V. Jounieaux, MD, PhD Respiratory Department, Amiens University Medical Center, Amiens, France
material (ESM)). All patients were sedated and paralyzed before PP. Respiratory parameters were recorded before and at the end of the first 16-hour PP session. The compliance of the respiratory system (Crs) was calculated as tidal volume/(plateau pressure minus end-expiratory pressure). Ventilator setting were not modified during PP; and FiO2 was adapted for a target SpO2 of 92%. Local IRB waived the need for written consent and data collection was approved by the French licensing authority (number: PI2020_843_0026). Oral and written information was provided to the patients and their families. All parameters were compared using a Wilcoxon rank-sum test and P \ 0.05 was considered as significant. Twenty-five patients were analyzed. Clinical data appear in ESM-table 1.- PP procedures sign
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