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. 2023 Jun;68(6):713-720.
doi: 10.4187/respcare.10597.

Hemodynamic Effects of Awake Prone Positioning With COVID-19 Acute Respiratory Failure

Matthias Jacquet-Lagrèze  1 , Zakaria Riad  2 , Philippe Portran  3 , Delphine Chesnel  3 , Rémi Schweizer  3 , Arnaud Ferarris  2 , Louis Jacquemet  3 , Martin Ruste  2 , Jean-Luc Fellahi  4
Affiliations

Hemodynamic Effects of Awake Prone Positioning With COVID-19 Acute Respiratory Failure

Matthias Jacquet-Lagrèze et al. Respir Care. 2023 Jun.

Abstract

Introduction: Awake prone positioning (PP) reduces need for intubation for patients with COVID-19 with acute respiratory failure. We investigated the hemodynamic effects of awake PP in non-ventilated subjects with COVID-19 acute respiratory failure.

Methods: We conducted a single-center prospective cohort study. Adult hypoxemic subjects with COVID-19 not requiring invasive mechanical ventilation receiving at least one PP session were included. Hemodynamic assessment was done with transthoracic echocardiography before, during, and after a PP session.

Results: Twenty-six subjects were included. We observed a significant and reversible increase in cardiac index (CI) during PP compared to supine position (SP): 3.0 ± 0.8 L/min/m2 in PP, 2.5 ± 0.6 L/min/m2 before PP (SP1), and 2.6 ± 0.5 L/min/m2 after PP (SP2, P < .001). A significant improvement in right ventricular (RV) systolic function was also evidenced during PP: The RV fractional area change was 36 ± 10% in SP1, 46 ± 10% during PP, and 35 ± 8% in SP2 (P < .001). There was no significant difference in PaO2 /FIO2 and breathing frequency.

Conclusion: CI and RV systolic function are improved by awake PP in non-ventilated subjects with COVID-19 with acute respiratory failure.

Keywords: ARDS; COVID-19; awake prone position; cardiac index; echocardiography; hemodynamic.

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Figures

Fig. 1.
Fig. 1.
Flow chart of the study. CI = cardiac index; PP = prone positioning.
Fig. 2.
Fig. 2.
Echocardiographic hemodynamic evolution during a prone position session. CI = cardiac index; ANOVA = analysis of variance; SP1 = supine position 1 (before PP); PP = prone positioning; SP2 = supine position 2 (after PP); PWC = pairwise comparison; LVEF = left ventricular ejection fraction; LVEDV = left ventricular end-diastolic volume; RVFAC = right ventricular fractional area change; RVESA = right ventricular end-systolic area; RVEDA = right ventricular end-diastolic area.
Fig. 3.
Fig. 3.
Respiratory and peripheral perfusion variables before, during, and after prone positioning. ANOVA = analysis of variance; SP1 = supine position 1 (before PP); PP = prone positioning; SP2 = supine position 2 (after PP); PWC = pairwise comparison; ROX = ratio of oxygen saturation; DO2 = oxygen delivery; CRT = capillary refill time.
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