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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2020

01-12-2020 | Acute Respiratory Distress-Syndrome | Research

Prone positioning monitored by electrical impedance tomography in patients with severe acute respiratory distress syndrome on veno-venous ECMO

Authors: Guillaume Franchineau, Nicolas Bréchot, Guillaume Hekimian, Guillaume Lebreton, Simon Bourcier, Pierre Demondion, Loïc Le Guennec, Ania Nieszkowska, Charles-Edouard Luyt, Alain Combes, Matthieu Schmidt

Published in: Annals of Intensive Care | Issue 1/2020

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Abstract

Background

Prone positioning (PP) during veno-venous ECMO is feasible, but its physiological effects have never been thoroughly evaluated. Our objectives were to describe, through electrical impedance tomography (EIT), the impact of PP on global and regional ventilation, and optimal PEEP level.

Methods

A monocentric study conducted on ECMO-supported severe ARDS patients, ventilated in pressure-controlled mode, with 14-cmH2O driving pressure and EIT-based “optimal PEEP”. Before, during and after a 16-h PP session, EIT-based distribution and variation of tidal impedance, VTdorsal/VTglobal ratio, end-expiratory lung impedance (EELI) and static compliance were collected. Subgroup analyses were performed in patients who increased their static compliance by ≥ 3 mL/cmH2O after 16 h of PP.

Results

For all patients (n = 21), tidal volume and EELI were redistributed from ventral to dorsal regions during PP. EIT-based optimal PEEP was significantly lower in PP than in supine position. Median (IQR) optimal PEEP decreased from 14 (12–16) to 10 (8–14) cmH2O. Thirteen (62%) patients increased their static compliance by ≥ 3 mL/cmH2O after PP on ECMO. This subgroup had higher body mass index, more frequent viral pneumonia, shorter ECMO duration, and lower baseline VTdorsal/VTglobal ratio than patients with compliance ≤ 3 mL/cmH2O (P < 0.01).

Conclusion

Although baseline tidal volume distribution on EIT may predict static compliance improvement after PP on ECMO, our results support physiological benefits of PP in all ECMO patients, by modifying lung mechanics and potentially reducing VILI. Further studies, including a randomized–controlled trial, are now warranted to confirm potential PP benefits during ECMO.
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Metadata
Title
Prone positioning monitored by electrical impedance tomography in patients with severe acute respiratory distress syndrome on veno-venous ECMO
Authors
Guillaume Franchineau
Nicolas Bréchot
Guillaume Hekimian
Guillaume Lebreton
Simon Bourcier
Pierre Demondion
Loïc Le Guennec
Ania Nieszkowska
Charles-Edouard Luyt
Alain Combes
Matthieu Schmidt
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2020
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-020-0633-5

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