Lung-Dependent Areas Collapse, Monitored by Electrical Impedance Tomography, May Predict the Oxygenation Response to Prone Ventilation in COVID-19 Acute Respiratory Distress Syndrome.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 07 2022
01 07 2022
Historique:
pubmed:
25
2
2022
medline:
24
6
2022
entrez:
24
2
2022
Statut:
ppublish
Résumé
ICUs have had to deal with a large number of patients with acute respiratory distress syndrome COVID-19, a significant number of whom received prone ventilation, which is a substantial consumer of care time. The selection of patients that we have to ventilate in prone position seems interesting. We evaluate the correlation between the percentage of collapsed dependent lung areas in the supine position, monitoring by electrical impedance tomography and the oxygenation response (change in Pao2/Fio2 ratio) to prone position. An observational prospective study. From October 21, 2020, to 30 March 30, 2021. At the Sainte Anne military teaching Hospital and the Timone University Hospital. Fifty consecutive patients admitted in our ICUs, with COVID-19 acute respiratory distress syndrome and required mechanical, were included. Twenty-four (48%) received prone ventilation. Fifty-eight prone sessions were investigated. An electrical impedance tomography recording was made in supine position, daily and repeated just before and just after the prone session. The daily dependent area collapse was calculated in relation to the previous electrical impedance tomography recording. Prone ventilation response was defined as a Pao2/Fio2 ratio improvement greater than 20%. The main outcome was the correlation between dependent area collapse and the oxygenation response to prone ventilation. Dependent area collapse was correlated with oxygenation response to prone ventilation (R2 = 0.49) and had a satisfactory prediction accuracy of prone response with an area under the curve of 0.94 (95% CI, 0.87-1.00; p < 0.001). Best Youden index was obtained for a dependent area collapse greater than 13.5 %. Sensitivity of 92% (95% CI, 78-97), a specificity of 91% (95% CI, 72-97), a positive predictive value of 94% (95% CI, 88-100), a negative predictive value of 87% (95% CI, 78-96), and a diagnostic accuracy of 91% (95% CI, 84-98). Dependent lung areas collapse (> 13.5%), monitored by electrical impedance tomography, has an excellent positive predictive value (94%) of improved oxygenation during prone ventilation.
Identifiants
pubmed: 35200196
doi: 10.1097/CCM.0000000000005487
pii: 00003246-202207000-00007
pmc: PMC9196922
doi:
Banques de données
ClinicalTrials.gov
['NCT04603755']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1093-1102Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
The authors have disclosed that they do not have any potential conflicts of interest.
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