Effects of Prone Ventilation on Oxygenation, Inflammation, and Lung Infiltrates in COVID-19 Related Acute Respiratory Distress Syndrome: A Retrospective Cohort Study

• Main Authors: Rohit Khullar, Shrey Shah, Gagandeep Singh, Joseph Bae, Rishabh Gattu, Shubham Jain, Jeremy Green, Thiruvengadam Anandarangam, Marc Cohen, Nikhil Madan, Prateek Prasanna
• Format: Article
• Language: English
• Published: MDPI AG 2020-12-01
• Series: Journal of Clinical Medicine
• Subjects: severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2); coronavirus disease 2019 (COVID-19); prone ventilation; acute respiratory distress syndrome (ARDS); prone positioning; diagnostic radiology
• Online Access: https://www.mdpi.com/2077-0383/9/12/4129

Patients receiving mechanical ventilation for coronavirus disease 2019 (COVID-19) related, moderate-to-severe acute respiratory distress syndrome (CARDS) have mortality rates between 76–98%. The objective of this retrospective cohort study was to identify differences in prone ventilation effects on oxygenation, pulmonary infiltrates (as observed on chest X-ray (CXR)), and systemic inflammation in CARDS patients by survivorship and to identify baseline characteristics associated with survival after prone ventilation. The study cohort included 23 patients with moderate-to-severe CARDS who received prone ventilation for ≥16 h/day and was segmented by living status: living (<i>n</i> = 6) and deceased (<i>n</i> = 17). Immediately after prone ventilation, PaO₂/FiO₂ improved by 108% (<i>p</i> < 0.03) for the living and 150% (<i>p</i> < 3 × 10⁻⁴) for the deceased. However, the 48 h change in lung infiltrate severity in gravity-dependent lung zones was significantly better for the living than for the deceased (<i>p</i> < 0.02). In CXRs of the lower lungs before prone ventilation, we observed 5 patients with confluent infiltrates bilaterally, 12 patients with ground-glass opacities (GGOs) bilaterally, and 6 patients with mixed infiltrate patterns; 80% of patients with confluent infiltrates were alive vs. 8% of patients with GGOs. In conclusion, our small study indicates that CXRs may offer clinical utility in selecting patients with moderate-to-severe CARDS who will benefit from prone ventilation. Additionally, our study suggests that lung infiltrate severity may be a better indicator of patient disposition after prone ventilation than PaO₂/FiO₂.