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Extent and Distribution of Parenchymal Abnormalities in Baseline CT-Scans Do Not Predict Awake Prone Positioning Response in COVID-19 Related ARDS.
- Source :
-
Diagnostics (Basel, Switzerland) [Diagnostics (Basel)] 2022 Jul 30; Vol. 12 (8). Date of Electronic Publication: 2022 Jul 30. - Publication Year :
- 2022
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Abstract
- Prone positioning is frequently used for non-intubated hypoxemic patients with COVID-19, although conclusive evidence is still lacking. The aim of the present study was to investigate whether baseline CT-scans could predict the improvement in oxygenation in COVID-19 related Acute respira-tory syndrome (ARDS) patients when pronated.<br />Methods: A retrospective study of COVID-19 patients who underwent non-invasive ventilation (NIV) and prone positioning was conducted.<br />Results: Forty-five patients were included. On average, 50% of the overall lung volume was affected by the disease, as observed in the CT-scans, with ground glass opacities (GGOs) and consolidations accounting for 44% and 4%, respectively. The abnormalities were mainly posterior, as demonstrated by posterior/anterior distribution ratios of 1.5 and 4.4 for GGO and consolidation, respectively. The median PaO <subscript>2</subscript> /FiO <subscript>2</subscript> ratio during NIV in a supine position (SP1) was 140 [IQR 108-169], which improved by 67% (+98) during prone positioning, on average. Once supine positioning was resumed (SP2), the improvement in oxygenation was maintained in 28 patients (62% of the overall population, categorized as "responders"). We found no significant differences between responders and non-responders in terms of the extent ( p = 0.92) and the distribution of parenchymal abnormalities seen in the baseline CT ( p = 0.526).<br />Conclusion: Despite the lack of a priori estimation of the sample size, considering the absence of any trends in the differences and correlations, we can reasonably conclude that the baseline chest CT-scan does not predict a gas-exchange response in awake prone-positioned patients with COVID-19 related ARDS. Physicians dealing with this category of patients should not rely on the imaging at presentation when evaluating whether to pronate patients.
Details
- Language :
- English
- ISSN :
- 2075-4418
- Volume :
- 12
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Diagnostics (Basel, Switzerland)
- Publication Type :
- Academic Journal
- Accession number :
- 36010199
- Full Text :
- https://doi.org/10.3390/diagnostics12081848