Cardiopulmonary Effects of Prone Position in CARDS

Bakirkoy Dr. Sadi Konuk Training and Research Hospital

Status: Completed

Conditions: ARDS Due to Disease Caused by SARS Co-V-2; Right Ventricular Dysfunction

Treatments: Procedure: the first hour of prone position; Procedure: the first hour of returning to the supine position; Procedure: before prone position

Study type: Observational

Funder types: Other

Identifiers

NCT06456606

2022/40

Details and patient eligibility

About

In coronavirus disease-2019 (COVID-19)-related ARDS (C-ARDS), especially in the severe form, increased shunt rate, impaired ventilation/perfusion ratio (V/Q), hypoxic pulmonary vasoconstriction inhibition, and increased immune microthrombosis may have similar effects on the right ventricle .The cardiopulmonary pathophysiology and outcomes of C-ARDS vary, and this variability requires monitoring to follow the diagnosis and treatment process. This study aimed to increase the treatment success of the prone position in C-ARDS and to provide a prognostic factor for survival by analyzing and monitoring heart-lung interactions. Therefore, we used transesophageal echocardiography (TEE) to evaluate the cardiopulmonary effects of prone position.

Full description

This prospective study included 30 moderate-to-severe C-ARDS patients who were treated with prone position in the first 48 hours of invasive mechanical ventilation support. It was evaluated with transesophageal echocardiography three times: before prone position (PP) (T0), the first hour of PP (T1), and the first hour of returning to the supine position (T0 + 24 hours) (T2) after 23 hours prone position treatment. Right ventricular end-diastolic area/left ventricular end-diastolic area (RVEDA/LVEDA) was preferred right ventricular evaluations as primer outcome. Static compliance (C-stat) was examined in the evaluation of the pulmonary effect of prone position as secondary outcome.

Enrollment: 30 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• >18 years
• Patients diagnosed with polymerase chain reaction/computed tomography results
• Moderate/severe severity class according to the Berlin ARDS classification
• Prone position applied in the first 48 h after orotracheal intubation in treatment
• Obtaining an informed consent form

Exclusion criteria

• Pulmonary embolism
• Pneumothorax
• Heart valve disease
• Pregnancy
• Perforated esophageal varices
• Coagulopathy
• Esophageal stricture
• Esophageal tumor
• Neck fracture
• Thrombocytopenia
• Gastrointestinal bleeding
• Previous stomach surgery
• Previous esophageal surgery
• Esophageal perforation

Trial design

30 participants in 1 patient group

group a

Description:

30 moderate-to-severe C-ARDS patients who were treated with prone position in the first 48 hours of invasive mechanical ventilation support. It was evaluated with transesophageal echocardiography three times: before prone position (T0), the first hour of prone position (T1), and the first hour of returning to the supine position (T0 + 24 hours) (T2) after 23 hours prone position treatment.

Treatment:

Procedure: before prone position

Procedure: the first hour of returning to the supine position

Procedure: the first hour of prone position