Abstract
Aim of the study. To examine the effect of prone positioning on hemodynamics in patients with COVID-19.Materials and methods. The study enrolled 84 patients of both sexes with community-acquired multisegmental viral and bacterial pneumonia associated with COVID-19, who were divided into groups according to the type of respiratory support. The tests were performed using the integrated hardware and software system for noninvasive central hemodynamic assessment by volumetric compression oscillometry.Results. We found that the pulse blood pressure velocity decreased from 281 [242.0; 314.0] to 252 [209; 304] mm Hg/s in patients with severe COVID-19 on oxygen support (p=0.005); volume ejection rate decreased from 251 [200; 294] to 226 [186; 260] ml/s (P=0.03); actual/estimated normalized vascular resistance ratio dropped from 0.549 [0.400; 0.700] to 0.450 [0.300; 0.600] (P=0.002), while the arterial wall compliance increased from 1.37 [1.28; 1.67] to 1.45[1.10; 1.60] ml/mm Hg (P=0.009). Prone positioning of patients on noninvasive lung ventilation associated with a reduction of linear blood flow rate from 40.0 [34.0; 42.0] to 42.5 [42.5; 47.25] cm/s (7=0.04) and arterial wall compliance from 1.4 [1.24; 1.50] to 1.32 [1.14; 1.49] ml/mm Hg (7=0.03). Prone positioning of patients on invasive lung ventilation did not result in significant hemodynamic changes.Conclusion. The greatest hemodynamic changes during prone positioning were found in patients on oxygen respiratory support, whereas the least significant alterations were seen in patients on invasive ventilatory support.
Highlights
В настоящий момент на территории России и других стран продолжается эпидемический процесс, вызванный коронавирусом SARS-CoV-2.Новый коронавирус SARS-CoV-2 представляет собой одноцепочечный РНК-содержащий вирус, относится к семейству Coronaviridae, относится к линии Beta-CoV B
We found that the pulse blood pressure velocity decreased from 281 [242.0; 314.0] to 252 [209; 304] mm Hg/s in patients with severe COVID-19 on oxygen support (p=0.005); volume ejection rate decreased from 251 [200; 294] to 226 [186; 260] ml/s (P=0.03); actual/estimated normalized vascular resistance ratio dropped from 0.549 [0.400; 0.700] to 0.450 [0.300; 0.600] (P=0.002), while the arterial wall compliance increased from 1.37 [1.28; 1.67] to 1.45[1.10; 1.60] ml/mm Hg (P=0.009)
When comparing the values in the set of blood pressure parameters, we found that pulse blood pressure velocity (PBPV) changed in patients on oxygen support after the position change
Summary
В настоящий момент на территории России и других стран продолжается эпидемический процесс, вызванный коронавирусом SARS-CoV-2. Новый коронавирус SARS-CoV-2 представляет собой одноцепочечный РНК-содержащий вирус, относится к семейству Coronaviridae, относится к линии Beta-CoV B. Вирус отнесен ко II группе патогенности, как и некоторые другие представители этого семейства (вирус SARSCoV, MERS-CoV) [1,2,3]. Только в России заболело уже более 1,1 млн человек, зарегистрировано более 19000 летальных исходов [4]. Covid-19 способен вызывать обширное поражение легочной ткани, в некоторых клинических ситуациях более 95%, что приводит к развитию дыхательной недостаточности. Большая площадь вовлеченной в патологический процесс обильно васкуляризованной легочной ткани способствует повреждению эндотелия. Эндотелиальная дисфункция связана с патогенезом сердечно-сосудистых, почечных, метаболических и инфекционных осложнений [5, 6]
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