Awake Prone Position to Reduce Ventilation Inhomogeneity in COVID-19 Acute Respiratory Failure

Assistance Publique Hopitaux De Marseille20 enrolled

Overview

Evaluation of awake prone position on ventilation inhomogeneity in COVID-19 associated respiratory failure.

Awake prone position has been proposed as an additional treatment to alleviate hypoxemia during COVID-19 acute respiratory failure and potentially to avoid in some case tracheal intubation and invasive ventilation. Potential mechanism is improvement of ventilation: perfusion mismatch through redistribution of ventilation to the dorsal part of the lungs where perfusion is prominent. Electrical impedance tomography (EIT) is a non-invasive functional lung imaging of distribution of ventilation. Therefore, we aim to assess EIT on lung ventilation inhomogeneity during supine and prone position in COVID-19 patients.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

SINGLE

Enrollment

Conditions

Respiratory Failure

Interventions

physiological effects of awake prone position in COVID 19 patientsOTHER

Study of physiological effects of awake prone position in COVID 19 patients on lung inhomogeneity assessed by Electrical Impedance Tomography (EIT), gas exchange and dyspnea score (Borg Scale). Measurements will be performed at baseline (on supine position), then patients will be randomized on the order of position, either supine then prone, either prone then supine. Each period will last at least 2 hours. EIT records will be performed during the last 30 minutes of each period, blood gas and dyspnea score at the end of each period.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * more than 18 Years (Adult, Older Adult) * Confirmed COVID-19 (positive SARS-CoV-2 RT-PCR at nasopharyngeal swab) * Acute respiratory failure with 100 \< PaO2:FiO2\< 300 mmhg * Spontaneous ventilation with standard oxygen supply or high flow humidified oxygen * Written informed consent of the patient Exclusion Criteria: * Contra-indication to prone position including pregnancy * Presence of pacemaker * Severe hypoxemia with PaO2/FiO2 \< 100 mmHg * Evidence of clinical signs of respiratory distress with high probability of intubation in the next two hours

Locations (1)

Assistance Publique Höpitaux de Marseille

Marseille, France

Outcomes

Primary Outcomes

Global Inhomogeneity Index variations (expressed in percentage) between baseline, supine and prone position periods.

Electrical Impedance Tomography (EIT)

Time frame: 2hours

Data from ClinicalTrials.gov

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