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Open Access 01-12-2022 | Acute Respiratory Distress-Syndrome | Research

Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients

Authors: Rollin Roldán, Shalim Rodriguez, Fernando Barriga, Mauro Tucci, Marcus Victor, Glasiele Alcala, Renán Villamonte, Fernando Suárez-Sipmann, Marcelo Amato, Laurent Brochard, Gerardo Tusman

Published in: Annals of Intensive Care | Issue 1/2022

Abstract

Background

A sequential change in body position from supine-to-both lateral positions under constant ventilatory settings could be used as a postural recruitment maneuver in case of acute respiratory distress syndrome (ARDS), provided that sufficient positive end-expiratory pressure (PEEP) prevents derecruitment. This study aims to evaluate the feasibility and physiological effects of a sequential postural recruitment maneuver in early mechanically ventilated COVID-19 ARDS patients.

Methods

A cohort of 15 patients receiving lung-protective mechanical ventilation in volume-controlled with PEEP based on recruitability were prospectively enrolled and evaluated in five sequentially applied positions for 30 min each: Supine-baseline; Lateral-1st side; 2nd Supine; Lateral-2nd side; Supine-final. PEEP level was selected using the recruitment-to-inflation ratio (R/I ratio) based on which patients received PEEP 12 cmH₂O for R/I ratio ≤ 0.5 or PEEP 15 cmH₂O for R/I ratio > 0.5. At the end of each period, we measured respiratory mechanics, arterial blood gases, lung ultrasound aeration, end-expiratory lung impedance (EELI), and regional distribution of ventilation and perfusion using electric impedance tomography (EIT).

Results

Comparing supine baseline and final, respiratory compliance (29 ± 9 vs 32 ± 8 mL/cmH₂O; p < 0.01) and PaO₂/FIO₂ ratio (138 ± 36 vs 164 ± 46 mmHg; p < 0.01) increased, while driving pressure (13 ± 2 vs 11 ± 2 cmH₂O; p < 0.01) and lung ultrasound consolidation score decreased [5 (4–5) vs 2 (1–4); p < 0.01]. EELI decreased ventrally (218 ± 205 mL; p < 0.01) and increased dorsally (192 ± 475 mL; p = 0.02), while regional compliance increased in both ventral (11.5 ± 0.7 vs 12.9 ± 0.8 mL/cmH₂O; p < 0.01) and dorsal regions (17.1 ± 1.8 vs 18.8 ± 1.8 mL/cmH₂O; p < 0.01). Dorsal distribution of perfusion increased (64.8 ± 7.3% vs 66.3 ± 7.2%; p = 0.01).

Conclusions

Without increasing airway pressure, a sequential postural recruitment maneuver improves global and regional respiratory mechanics and gas exchange along with a redistribution of EELI from ventral to dorsal lung areas and less consolidation.

Trial registration ClinicalTrials.gov, NCT04475068. Registered 17 July 2020, https://clinicaltrials.gov/ct2/show/NCT04475068

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Title: Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients
Authors: Rollin Roldán
Shalim Rodriguez
Fernando Barriga
Mauro Tucci
Marcus Victor
Glasiele Alcala
Renán Villamonte
Fernando Suárez-Sipmann
Marcelo Amato
Laurent Brochard
Gerardo Tusman
Publication date: 01-12-2022
Publisher: Springer International Publishing
Keywords: Acute Respiratory Distress-Syndrome
COVID-19
Lung Ultrasound
Published in: Annals of Intensive Care / Issue 1/2022
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-022-00988-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sequential lateral positioning as a new lung recruitment maneuver: an exploratory study in early mechanically ventilated Covid-19 ARDS patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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