Abstract
BackgroundThis study was conceived to provide systematic data about lung mechanics during early phases of CoVID-19 pneumonia, as long as to explore its variations during prone positioning.MethodsWe enrolled four patients hospitalized in the Intensive Care Unit of “M. Bufalini” hospital, Cesena (Italy); after the positioning of an esophageal balloon, we measured mechanical power, respiratory system and transpulmonary parameters and arterial blood gases every 6 hours, just before decubitus change and 1 hour after prono-supination.ResultsBoth respiratory system and transpulmonary compliance and driving pressure confirmed the pseudo-normal respiratory mechanics of early CoVID-19 pneumonia (respectively, CRS 40.8 ml/cmH2O and DPRS 9.7 cmH2O; CL 53.1 ml/cmH2O and DPL 7.9 cmH2O). Interestingly, prone positioning involved a worsening in respiratory mechanical properties throughout time (CRS,SUP 56.3 ml/cmH2O and CRS,PR 41.5 ml/cmH2O – P 0.37; CL,SUP 80.8 ml/cmH2O and CL,PR 53.2 ml/cmH2O – P 0.23).ConclusionsDespite the severe ARDS pattern, respiratory system and lung mechanical properties during CoVID-19 pneumonia are pseudo-normal and tend to worsen during pronation.Trial registrationRestrospectively registered.
Highlights
This study was conceived to provide systematic data about lung mechanics during early phases of CoVID-19 pneumonia, as long as to explore its variations during prone positioning
Mechanical ventilation and muscular paralysis are recommended in worsening respiratory insufficiency [2]; in a substantial number of cases, prone positioning significantly improves oxygenation
Chest computed tomography (CT) showed interstitial pneumonia without loss of parenchymal aeration; patients were put on mechanical ventilation within 24 hours of hospital admission
Summary
This study was conceived to provide systematic data about lung mechanics during early phases of CoVID-19 pneumonia, as long as to explore its variations during prone positioning. In January, 2020, it has been clear that CoVID-19 pneumonia is atypical. Despite a full concordance to Berlin criteria for Acute Respiratory Distress Syndrome (ARDS), respiratory system mechanics is preserved [1]. Mechanical ventilation and muscular paralysis are recommended in worsening respiratory insufficiency [2]; in a substantial number of cases, prone positioning significantly improves oxygenation. Little is known about isolated lung behavior in CoVID-19 pneumonia. The aim of this study is to analyze lung mechanical properties in the first hours
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