Profile of Patients Responding to Positive End-Expiratory Pressure and Prone Position during ARDS Related to COVID-19: A Case of the Sens Hospital — Oak Academic Publishing
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Profile of Patients Responding to Positive End-Expiratory Pressure and Prone Position during ARDS Related to COVID-19: A Case of the Sens Hospital
Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Resuscitation Department, Sens Hospital, Sens, France
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Makala General Reference Hospital, Kinshasa, Democratic Republic of the Congo
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Department of Public Health and Epidemiology, University of Montpellier, Montpellier, France
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Resuscitation Department, Sens Hospital, Sens, France
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Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
,
Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
,
Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
,
Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Department of Anaesthesia and Intensive Care, Protestant University of Congo, Kinshasa, Democratic Republic of the Congo
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Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Department of Anaesthesia and Intensive Care, Monkole Hospital, Kinshasa, Democratic Republic of the Congo
1 Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
2 Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
3 Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
4 Resuscitation Department, Sens Hospital, Sens, France
5 Makala General Reference Hospital, Kinshasa, Democratic Republic of the Congo
6 Department of Public Health and Epidemiology, University of Montpellier, Montpellier, France
7 Resuscitation Department, Sens Hospital, Sens, France
8 Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
9 Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
10 Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
11 Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
12 Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
13 Department of Anaesthesia and Intensive Care, Protestant University of Congo, Kinshasa, Democratic Republic of the Congo
14 Department of Anaesthesia and Intensive Care, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
15 Department of Anaesthesia and Intensive Care, Monkole Hospital, Kinshasa, Democratic Republic of the Congo
Background : There is a paucity of data on the efficacy of ventilatory strategies in COVID-19-related ARDS. The aim of this study was to describe the effect of positive end-expiratory pressure (PEEP) and prone position (PP) on oxygenation and determine the profile of responders. Methods : This was a cross-sectional study of patients admitted to the intensive care unit of the Sens Hospital with COVID-19-related ARDS who were invasively ventilated for more than 24 hours between 1 March 2020 and 2 March 2021. A good oxygenation response to PEEP and/or PP was defined as an increase in the PaO 2 /FiO 2 ratio (pre-post) of more than 20% within 4 hours after the application of these measures. Results : Forty patients were recruited, 28 of whom were men. Standard ventilation allowed us to observe 3 subgroups of patients: 5 (12.5%) requiring protective ventilation with a PEP ≤ 8 cmH 2 O, 5 (12.5%) requiring protective ventilation with a PEEP > 8 cmH 2 O, and finally 30 (75%) requiring protective ventilation with a PEEP > 8 cmH 2 O combined with PP sessions. Almost all (80%) of the patients (the majority of whom were obese) placed on PP with PEP > 8 cmH 2 O had a good response to oxygenation. No characteristic was associated with non-response. Conclusion : The use of PEEP and the use of prone position increased the PaO 2 /FiO 2 ratio in the vast majority of patients, particularly those who were obese. No characteristic was associated with non-response, so prone position can be offered to those with the indication. A high-powered study is needed to confirm this profile and assess the benefit of PP on mortality.
KeywordsARDSCOVID-19Positive End-Expiratory PressureOxygenationProne Position
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