The prone position during mechanical ventilation in patients with Acute Respiratory Distress Syndrome (ARDS) is able to improve oxygenation and thus reduce mortality. The objective of the study is to evaluate the ability of the prone position to increase the oxygenation of the patient with SARS-cov-2 pneumonia.
BACKGROUND:
It has been shown that the prone position (PP) during mechanical ventilation (VM) in patients
with Acute Respiratory Distress Syndrome (ARDS) is able to improve oxygenation and thus
reduce mortality.
The reduced mortality, however, is not only caused by an increase in oxygen, but also by the
ability of the PP to reduce the damage associated with mechanical ventilation (VILI).
Studies show that the benefits of PP are also present in non-intubated patients; the PP
prevents the need for intubation and the consequent risk deriving from the procedure itself
and from the predisposition to develop superinfections (VAP).
Moreover, a reduction in the need for intubation and therefore hospitalization in the ICU
would be particularly useful in a context of great health emergency with limited resources.
The objective of the study is to value the ability of the prone position to increase the
oxygenation of the patient with SARS-cov-2 pneumonia as a lung recruitment index.
STUDY DESIGN:
This is a monocentric study that will be conducted on all patients admitted to the Infectious
Diseases and UTIR units of the S. Gerardo Hospital in Monza with the diagnosis of related
COVID pneumonia requiring oxygen support or CPAP.
Sample size (n. Patients): 56
The duration of enrollment is estimated in 1 month. Patients will be monitored until
discharged from the hospital. The overall duration of the study is estimated to be 1 year
(including enrollment, follow up and data analysis).
The patient will be enrolled in the study when consent is obtained. The following data will
be collected:
- Patient registration
- Demographic and anthropometric data
- Comorbidity and lifestyle habits
- Hospitalization data
- Blood chemistry tests
- Ventilation parameters
After 10 minutes and at the end of pronation, the feasibility of pronation and ventilation
parameters will also be assessed.
STATISTICAL ANALYSIS:
Clinical data relating to enrolled patients will be analysed by means of descriptive
statistics on continuous quantitative variables using indicators chosen on the basis of the
distributional form. Categorical variables will be described in percentages. Hypotheses on
PaO2 / FiO2 performance will be verified through the T test for paired data if the
distributional form allows it or alternatively the Wilcoxon test will be used. In this case
we will proceed with a recalculation of the power study.
Procedure: Prone position
The objective of the study is to value the ability of the prone position to increase the oxygenation of the patient with SARS-cov-2 pneumonia as a lung recruitment index; the PP also prevents the need for intubation and the consequent risk deriving from the procedure itself and from the predisposition to develop superinfections (VAP).
Other Name: PP
Inclusion Criteria:
- Age> = 18 years old or <= 75 years old
- Diagnosis of COVID related pneumonia requiring oxygen or CPAP support
Exclusion Criteria:
- pregnant patients
- patients with impaired consciousness and / or uncooperative
- patients with NYHA class> II
- patients with high proBNP
- patients with COPD
- contraindications evidenced by the physicians
ASST Monza
Monza, MB, Italy
Giuseppe Foti, Prof., Principal Investigator
ASST Monza-University Milano Bicocca