Lung impedance changes during awake prone positioning in COVID-19. A non-randomized cross-over study

Jacob Rosén; Peter Frykholm; Malin Jonsson Fagerlund; Mariangela Pellegrini; Francesca Campoccia Jalde; Erik von Oelreich; Diddi Fors

doi:10.1371/journal.pone.0299199

Lung impedance changes during awake prone positioning in COVID-19. A non-randomized cross-over study

PLoS One. 2024 Feb 21;19(2):e0299199. doi: 10.1371/journal.pone.0299199. eCollection 2024.

Authors

Jacob Rosén¹, Peter Frykholm¹, Malin Jonsson Fagerlund^{2

3}, Mariangela Pellegrini¹, Francesca Campoccia Jalde^{2

4}, Erik von Oelreich^{2

3}, Diddi Fors¹

Affiliations

¹ Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
² Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
³ Section of Anesthesiology and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden.
⁴ Section of Thoracic Anesthesiology and Intensive Care, Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden.

Abstract

Background: The effects of awake prone positioning (APP) on respiratory mechanics in patients with COVID-19 are not well characterized. The aim of this study was to investigate changes of global and regional lung volumes during APP compared with the supine position using electrical lung impedance tomography (EIT) in patients with hypoxemic respiratory failure due to COVID-19.

Materials and methods: This exploratory non-randomized cross-over study was conducted at two university hospitals in Sweden between January and May 2021. Patients admitted to the intensive care unit with confirmed COVID-19, an arterial cannula in place, a PaO2/FiO2 ratio <26.6 kPa (<200 mmHg) and high-flow nasal oxygen or non-invasive ventilation were eligible for inclusion. EIT-data were recorded at supine baseline, at 30 and 60 minutes after APP-initiation, and 30 minutes after supine repositioning. The primary outcomes were changes in global and regional tidal impedance variation (TIV), center of ventilation (CoV), global and regional delta end-expiratory lung-impedance (dEELI) and global inhomogeneity (GI) index at the end of APP compared with supine baseline. Data were reported as median (IQR).

Results: All patients (n = 10) were male and age was 64 (47-73) years. There were no changes in global or regional TIV, CoV or GI-index during the intervention. dEELI increased from supine reference value 0 to 1.51 (0.32-3.62) 60 minutes after APP (median difference 1.51 (95% CI 0.19-5.16), p = 0.04) and returned to near baseline values after supine repositioning. Seven patients (70%) showed an increase >0.20 in dEELI during APP. The other EIT-variables did not change during APP compared with baseline.

Conclusion: Awake prone positioning was associated with a transient lung recruiting effect without changes in ventilation distribution measured with EIT in patients with hypoxemic respiratory failure due to COVID-19.

Copyright: © 2024 Rosén et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Clinical Trial

MeSH terms

Aged
COVID-19*
Cross-Over Studies
Electric Impedance
Female
Humans
Lung
Male
Middle Aged
Prone Position
Respiratory Insufficiency*
Wakefulness

Grants and funding

This work was supported by grants from the Swedish Heart–Lung Foundation (Grant 20210061) to PF and MJF (https://www.hjart-lungfonden.se/) as well as financial support from the David and Astrid Hagelén Foundation (no grant number) to EvO (https://staff.ki.se/david-and-astrid-hagelen-foundation). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.