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The purpose of this study is to determine the efects of prone positioning on the recruitment- to-inflation ratio in COVID-19 patients with acute respiratory distress syndrome.
High positive end-expiratory pressure (PEEP) level and prone positioning (PP) are recommended in patients with moderate to severe acute respiratory distress syndrome (ARDS) in order to recruit lung and thus to improve oxygenation. Thus, high PEEP level and prone positioning will be more effective in patients with high potential for lung recruitment. Recently, the Recruitment-to-Inflation Ratio (R/I ratio) has been described and validated in patients with ARDS to estimate the potential for lung recruitment. In this regard, the R/I ration may be of interest to titrate PEEP level in patients with ARDS. This would be of particular interest in COVID-19 patients with ARDS, since different ARDS phenotypes with heterogeneous potential of lung recruitment have been described in these patients. However, the effects of prone positioning on R/I ratio have been scarcely described so far. Thus, the main goal of this study is to investigate the effects of prone positioning on the R/I ratio in COVID-19 patients with ARDS. The second goal of this study is to determine the effects of prone positioning on oxygenation and respiratory mechanics according to the R/I ratio.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Prone positioning session |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Prone positioning session | Procedure | To perform respiratory measurements before, during and after a prone positioning session. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Prone positioning-induced decrease in R/I ratio. | The R/I ratio will be calculated before (within 30 minutes before), during (2h, 8h and 16h) and after (2h and 4h after) a prone positioning session. | 16-hour prone positioning session and 4-hour period after supine repositioning |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients "responders" to prone positioning session | The R/I ratio will be calculated before (within 30 minutes before), during (2h, 8h and 16h) and after (2h and 4h after) a prone positioning session. | 16-hour prone positioning session and 4-hour period after supine repositioning |
| Clinical and respiratory predictors of prone positioning response in terms of oxygenation |
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Inclusion Criteria:
Exclusion Criteria:
Age <18 years and pregnant women
Patients under legal protection
Acute core pulmonale
Pneumothorax and/or chest drainage
Hemodynamic failure
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Eligible patients are COVID-19 patients with moderate to severe ARDS under mechanical ventilation in whom prone positioning is indicated.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU de NICE | Nice | 06200 | France |
No sharing data plan is sheduled.
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| ID | Term |
|---|---|
| D000086382 | COVID-19 |
| ID | Term |
|---|---|
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
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TROC curves of clinical and biological variables for prediction of response to prone positioning |
| 16-hour prone positioning session and 4-hour period after supine repositioning |
| D014777 |
| Virus Diseases |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |