Awake Prone Position to Reduce Ventilation Inhomogeneity in COVID-19 Acute Respiratory Failure

Awake Prone Position to Reduce Ventilation Inhomogeneity in COVID-19 Acute Respiratory Failure: a Randomized Cross Over Electrical Impedance Tomography Study

Evaluation of awake prone position on ventilation inhomogeneity in COVID-19 associated respiratory failure.

Awake prone position has been proposed as an additional treatment to alleviate hypoxemia during COVID-19 acute respiratory failure and potentially to avoid in some case tracheal intubation and invasive ventilation. Potential mechanism is improvement of ventilation: perfusion mismatch through redistribution of ventilation to the dorsal part of the lungs where perfusion is prominent. Electrical impedance tomography (EIT) is a non-invasive functional lung imaging of distribution of ventilation. Therefore, we aim to assess EIT on lung ventilation inhomogeneity during supine and prone position in COVID-19 patients.

Inclusion Criteria:

• more than 18 Years (Adult, Older Adult)
• Confirmed COVID-19 (positive SARS-CoV-2 RT-PCR at nasopharyngeal swab)
• Acute respiratory failure with 100 < PaO2:FiO2< 300 mmhg
• Spontaneous ventilation with standard oxygen supply or high flow humidified oxygen
• Written informed consent of the patient

Exclusion Criteria:

• Contra-indication to prone position including pregnancy
• Presence of pacemaker
• Severe hypoxemia with PaO2/FiO2 < 100 mmHg
• Evidence of clinical signs of respiratory distress with high probability of intubation in the next two hours