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Available online 14 August 2023
Changes in pulmonary mechanics from supine to prone position measured through esophageal manometry in critically ill patients with COVID-19 severe acute respiratory distress syndrome
Cambios en la mecánica pulmonar producidos por el cambio de la posición supina a la posición prono medidos por manometría esofágica en pacientes críticamente enfermos con Síndrome de Distrés Respiratorio Severo por COVID-19
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Ismael Maldonado-Beltrána, Martín Armando Ríos-Ayalaa, Iván Armando Osuna-Padillaa, Nadia Carolina Rodríguez-Moguelb, Gustavo Lugo-Goytiaa, Carmen Margarita Hernández-Cárdenasa,
Corresponding author
cmhcar@hotmail.com

Corresponding author.
a Departamento de Áreas Críticas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
b Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
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Table 1. Clinical and demographical characteristics of patients with ARDS and COVID-19.
Table 2. Pulmonary mechanics in critically-ill patients with COVID-19 when changing from SP to PP.
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Abstract
Objective

To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19.

Design

Retrospective cohort.

Setting

Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City).

Patients

COVID-19 patients on MV due to ARDS, with criteria for PP.

Intervention

Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry.

Main variables of interest

Changes in lung and thoracic wall mechanics in SP and PP

Results

Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p=0.02), lung strain (0.74 vs 0.57, p=0.02), lung elastance (p=0.01), chest wall elastance (p=0.003) and relation of respiratory system elastances (p=0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p=0.19) and transpulmonary pressure during inspiration (p=0.70).

Conclusions

Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.

Keywords:
Critically ill
Pulmonary mechanics
Prone position
Esophageal pressure
Esophageal manometry
Resumen
Objetivo

Describir los cambios en la mecánica pulmonar de posición supino (SP) a posición prono (PP) en pacientes con ventilación mecánica (VM) con Sindrome de Insuficiencia Respiratoria Agudo Severo (SDRA) por COVID-19.

Diseño

Cohorte retrospective.

Ámbito

Unidad de Cuidados Intensivos Respiratorios del Instituto Nacional de Enfermedades Respiratorias, Ciudad de México.

Pacientes

Se incluyeron un total de 19 pacientes con criterios para PP.

Intervenciones

medición de la mecánica pulmonar en pacientes de SP a PP utilizando manometría esofágica.

Variables de interés principales

Cambios en la mecanica pulmonar y de la pared torácica, medidas mediante manometría esofágica de posición supino a posición prono.

Resultados

Se observó una disminución en los valores medidos de estrés pulmonar (10,6 vs 7,7, p=0,02), “strain” pulmonar (0,74 vs 0,57, p=0,02), elastancia pulmonar (p=0,01), elastancia de la pared torácica (p=0,003) y en la relación de las elastancias del sistema respiratorio (p=0,001) tras el cambio de SP a PP. No se encontraron diferencias en la presión de conducción (p=0,19) ni en la presión transpulmonar durante la inspiración.

Conclusiones

Se observaron cambios en la mecánica pulmonar al comparar los valores en posición supino y los medidos 24horas posteriores a la posición prono. El monitoreo de la presión esofágica puede ser de utilidad para el manejo del ventilador independientemente e la posición del paciente.

Palabras clave:
Pacientes críticos
Mecánica pulmonar
Posición prono
Presión esofágica
Manometría esofágica

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