Changes in pulmonary mechanics from supine to prone position measured through esophageal manometry in critically ill patients with COVID-19 severe acute respiratory distress syndrome

Abstract

Objective

To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19.

Design

Retrospective cohort.

Setting

Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City).

Patients

COVID-19 patients on MV due to ARDS, with criteria for PP.

Intervention

Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry.

Main variables of interest

Changes in lung and thoracic wall mechanics in SP and PP

Results

Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p = 0.02), lung strain (0.74 vs 0.57, p = 0.02), lung elastance (p = 0.01), chest wall elastance (p = 0.003) and relation of respiratory system elastances (p = 0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p = 0.19) and transpulmonary pressure during inspiration (p = 0.70).

Conclusions

Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24 h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.