Hemodynamic response to positive end-expiratory pressure and prone position in COVID-19 ARDS.
Aged
Aged, 80 and over
Blood Pressure
/ physiology
COVID-19
/ physiopathology
Female
Heart Rate
/ physiology
Hemodynamic Monitoring
Humans
Intensive Care Units
Italy
Male
Middle Aged
Outcome and Process Assessment, Health Care
Oxygen Consumption
/ physiology
Positive-Pressure Respiration
Prone Position
/ physiology
Vascular Resistance
/ physiology
ARDS
COVID-19
Cardiac output
Hemodynamic monitoring
PEEP
Prone position
Pulmonary artery catheter
Pulmonary shunt
SARS-CoV-2
Journal
Respiratory physiology & neurobiology
ISSN: 1878-1519
Titre abrégé: Respir Physiol Neurobiol
Pays: Netherlands
ID NLM: 101140022
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
07
11
2021
revised:
16
12
2021
accepted:
13
01
2022
pubmed:
18
1
2022
medline:
15
2
2022
entrez:
17
1
2022
Statut:
ppublish
Résumé
Use of high positive end-expiratory pressure (PEEP) and prone positioning is common in patients with COVID-19-induced acute respiratory failure. Few data clarify the hemodynamic effects of these interventions in this specific condition. We performed a physiologic study to assess the hemodynamic effects of PEEP and prone position during COVID-19 respiratory failure. Nine adult patients mechanically ventilated due to COVID-19 infection and fulfilling moderate-to-severe ARDS criteria were studied. Respiratory mechanics, gas exchange, cardiac output, oxygen consumption, systemic and pulmonary pressures were recorded through pulmonary arterial catheterization at PEEP of 15 and 5 cmH High PEEP improved PaO In patients with moderate-to-severe ARDS due to COVID-19, PEEP and prone position improve arterial oxygenation. Changes in cardiac output contribute to the effects of PEEP but not of prone position, which appears the most effective intervention to improve oxygenation with no hemodynamic side effects.
Sections du résumé
BACKGROUND
Use of high positive end-expiratory pressure (PEEP) and prone positioning is common in patients with COVID-19-induced acute respiratory failure. Few data clarify the hemodynamic effects of these interventions in this specific condition. We performed a physiologic study to assess the hemodynamic effects of PEEP and prone position during COVID-19 respiratory failure.
METHODS
Nine adult patients mechanically ventilated due to COVID-19 infection and fulfilling moderate-to-severe ARDS criteria were studied. Respiratory mechanics, gas exchange, cardiac output, oxygen consumption, systemic and pulmonary pressures were recorded through pulmonary arterial catheterization at PEEP of 15 and 5 cmH
RESULTS
High PEEP improved PaO
CONCLUSIONS
In patients with moderate-to-severe ARDS due to COVID-19, PEEP and prone position improve arterial oxygenation. Changes in cardiac output contribute to the effects of PEEP but not of prone position, which appears the most effective intervention to improve oxygenation with no hemodynamic side effects.
Identifiants
pubmed: 35038571
pii: S1569-9048(22)00003-9
doi: 10.1016/j.resp.2022.103844
pmc: PMC8759096
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
103844Informations de copyright
Copyright © 2022 Elsevier B.V. All rights reserved.
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