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European Journal of Medical Research
Published in: European Journal of Medical Research 1/2023

Open Access 01-12-2023 | Acute Respiratory Distress-Syndrome | Research

Improved oxygenation in prone positioning of mechanically ventilated patients with COVID-19 acute respiratory distress syndrome is associated with decreased pulmonary shunt fraction: a prospective multicenter study

Authors: Piotr Harbut, Francesca Campoccia Jalde, Martin Dahlberg, Anders Forsgren, Elisabeth Andersson, Andreas Lundholm, Jaroslaw Janc, Patrycja Lesnik, Michal Suchanski, Pawel Zatorski, Janusz Trzebicki, Tomasz Skalec, Mattias Günther

Published in: European Journal of Medical Research | Issue 1/2023

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Abstract

Background

Prone position is used in acute respiratory distress syndrome and in coronavirus disease 2019 (Covid-19) acute respiratory distress syndrome (ARDS). However, physiological mechanisms remain unclear. The aim of this study was to determine whether improved oxygenation was related to pulmonary shunt fraction (Q’s/Q’t), alveolar dead space (Vd/Vtalv) and ventilation/perfusion mismatch (V’A/Q’).

Methods

This was an international, prospective, observational, multicenter, cohort study, including six intensive care units in Sweden and Poland and 71 mechanically ventilated adult patients.

Results

Prone position increased PaO2:FiO2 after 30 min, by 78% (83–148 mm Hg). The effect persisted 120 min after return to supine (p < 0.001). The oxygenation index decreased 30 min after prone positioning by 43% (21–12 units). Q’s/Q’t decreased already after 30 min in the prone position by 17% (0.41–0.34). The effect persisted 120 min after return to supine (p < 0.005). Q’s/Q’t and PaO2:FiO2 were correlated both in prone (Beta -137) (p < 0.001) and in the supine position (Beta -270) (p < 0.001). V’A/Q’ was unaffected and did not correlate to PaO2:FiO2 (p = 0.8). Vd/Vtalv increased at 120 min by 11% (0.55–0.61) (p < 0.05) and did not correlate to PaO2:FiO2 (p = 0.3). The ventilatory ratio increased after 30 min in the prone position by 58% (1.9–3.0) (p < 0.001). PaO2:FiO2 at baseline predicted PaO2:FiO2 at 30 min after proning (Beta 1.3) (p < 0.001).

Conclusions

Improved oxygenation by prone positioning in COVID-19 ARDS patients was primarily associated with a decrease in pulmonary shunt fraction. Dead space remained high and the global V’A/Q’ measure could not explain the differences in gas exchange.
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Metadata
Title
Improved oxygenation in prone positioning of mechanically ventilated patients with COVID-19 acute respiratory distress syndrome is associated with decreased pulmonary shunt fraction: a prospective multicenter study
Authors
Piotr Harbut
Francesca Campoccia Jalde
Martin Dahlberg
Anders Forsgren
Elisabeth Andersson
Andreas Lundholm
Jaroslaw Janc
Patrycja Lesnik
Michal Suchanski
Pawel Zatorski
Janusz Trzebicki
Tomasz Skalec
Mattias Günther
Publication date
01-12-2023
Publisher
BioMed Central
Published in
European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-023-01559-9

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