Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34236
Title: Magnitude and time to peak oxygenation effect of prone positioning in ventilated adults with COVID-19 related acute hypoxemic respiratory failure.
Austin Authors: Rollinson, Thomas C ;McDonald, Luke A ;Rose, Joleen W ;Eastwood, Glenn M ;Costa-Pinto, Rahul;Modra, Lucy J ;Maeda, Akinori;Bacolas, Zoe;Anstey, James;Bates, Samantha;Bradley, Scott;Dumbrell, Jodi;French, Craig;Ghosh, Angaj;Haines, Kimberley J ;Haydon, Tim;Hodgson, Carol;Holmes, Jennifer;Leggett, Nina;McGain, Forbes;Moore, Cara;Nelson, Kathleen;Presneill, Jeffrey;Rotherham, Hannah;Said, Simone;Young, Meredith;Zhao, Peinan;Udy, Andrew;Chaba, Anis;Bellomo, Rinaldo ;Neto, Ary Serpa
Affiliation: Intensive Care
Physiotherapy
Institute for Breathing and Sleep
Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia.;Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.;Department of Intensive Care, Western Health, Melbourne, Victoria, Australia.
Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia.;Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.;Department of Intensive Care, Western Health, Melbourne, Victoria, Australia.
Department of Intensive Care, Northern Health, Melbourne, Victoria, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.;Department of Intensive Care, Western Health, Melbourne, Victoria, Australia.;Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia.
Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.;Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia.;Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.;Department of Intensive Care, Western Health, Melbourne, Victoria, Australia.;Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia.;Department of Intensive Care, Western Health, Melbourne, Victoria, Australia.
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Intensive Care, Northern Health, Melbourne, Victoria, Australia.
Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia.
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia.
Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia.;Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
Issue Date: Mar-2024
Date: 2023
Publication information: Acta Anaesthesiologica Scandinavica 2024-03; 68(3)
Abstract: Prone positioning may improve oxygenation in acute hypoxemic respiratory failure and was widely adopted in COVID-19 patients. However, the magnitude and timing of its peak oxygenation effect remain uncertain with the optimum dosage unknown. Therefore, we aimed to investigate the magnitude of the peak effect of prone positioning on the PaO2 :FiO2 ratio during prone and secondly, the time to peak oxygenation. Multi-centre, observational study of invasively ventilated adults with acute hypoxemic respiratory failure secondary to COVID-19 treated with prone positioning. Baseline characteristics, prone positioning and patient outcome data were collected. All arterial blood gas (ABG) data during supine, prone and after return to supine position were analysed. The magnitude of peak PaO2 :FiO2 ratio effect and time to peak PaO2 :FIO2 ratio effect was measured. We studied 220 patients (mean age 54 years) and 548 prone episodes. Prone positioning was applied for a mean (±SD) 3 (±2) times and 16 (±3) hours per episode. Pre-proning PaO2 :FIO2 ratio was 137 (±49) for all prone episodes. During the first episode. the mean PaO2 :FIO2 ratio increased from 125 to a peak of 196 (p < .001). Peak effect was achieved during the first episode, after 9 (±5) hours in prone position and maintained until return to supine position. In ventilated adults with COVID-19 acute hypoxemic respiratory failure, peak PaO2 :FIO2 ratio effect occurred during the first prone positioning episode and after 9 h. Subsequent episodes also improved oxygenation but with diminished effect on PaO2 :FIO2 ratio. This information can help guide the number and duration of prone positioning episodes.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34236
DOI: 10.1111/aas.14356
ORCID: 0000-0001-8973-661X
0000-0002-8613-1946
Journal: Acta Anaesthesiologica Scandinavica
PubMed URL: 37944557
ISSN: 1399-6576
Type: Journal Article
Subjects: ARDS
COVID-19
mechanical ventilation
prone positioning
Appears in Collections:Journal articles

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