Respiratory failure & ventilation
Time-dependent effects of prone position on ventilation-perfusion matching assessed by electrical impedance tomography in patients with COVID-19 acute respiratory distress syndrome (ARDS): sub-analysis of a prospective physiological study
Authors' conclusion
In COVID-19-induced ARDS patients, prone positioning initially improves oxygenation and V/Q matching by enhancing ventilation distribution and decreasing low V/Q (%). Over time, perfusion changes further improve V/Q matching, but these benefits diminish once the patient returns to the supine position, leading to increased V/Q mismatch.
Study context
- Population
- Mechanically ventilated patients with COVID-19 ARDS undergoing their first prone positioning (PP) session
- Participants
- 18 participants
- Comparison
- Prone position time points and return to supine vs supine baseline
- Primary endpoint
- Regional V/Q matching and distribution of ventilation and perfusion (electrical impedance tomography (EIT)) and PaO2/FiO2 during the initial PP session
Methodological detailslongitudinal, sub-analysis
- Longitudinal
- Sub-analysis
Primary result
As reported in the abstract
Oxygenation, ventilation, perfusion and V/Q matching by EIT
- PaO2/FiO2 increased at each PP time point vs supine position (SP), peaking at PPend
- Dorsal perfusion unchanged during first 3 h of PP; significantly increased by PPend
- Ventilation and perfusion returned to baseline at reverting to the supine position (RE-SP3)
- PP increased normal V/Q (%) and decreased non-perfused (%) and low V/Q (%), particularly dorsally, vs SP
- At RE-SP3, marked increase in non-ventilated (%), low V/Q (%) and non-perfused (%) vs PP
- GI-V/Q ratio decreased during PP and correlated with increase in PaO2/FiO2
- PP1 vs SP: P = 0.047
- PPend vs PP1: P < 0.001
Original publication
Time-dependent effects of prone position on ventilation-perfusion matching assessed by electrical impedance tomography in patients with COVID-19 ARDS: sub-analysis of a prospective physiological study. Ann Intensive Care. Published 31 March 2025. doi:10.
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