Ventilation-Perfusion Matching in Early-stage Prone Position Ventilation

Ventilation-Perfusion Matching in Early-stage Prone Position Ventilation: A Comparison Between COVID-19 ARDS and ARDS From Other Etiologies

Prone positioning has been widely used in critical care medicine to improve oxygenation in patients with acute respiratory distress syndrome (ARDS). This study aimed to compare the effect of pronation on lung ventilation-perfusion matching between COVID19-associated acute respiratory distress syndrome (CARDS) and ARDS from other etiologies (non-CARDS) using electrical impedance tomography (EIT).

Study Overview

• Status: Completed
• Conditions: Acute Respiratory Distress Syndrome

Detailed Description

In this prospective study, both COVID19-associated ARDS (CARDS) patients and patients with ARDS from other etiologies (non-CARDS) were enrolled. Electrical impedance tomography (EIT) was used to evaluate the changes in ventilation and perfusion between supine and prone positions. Baseline values of the area of DeadSpace, shunt, ventilation-perfusion matching (VQmatch) were identified at the time of enrollment. Within the defined VQmatch region, the global inhomogeneity index (VQmatch-GI) was calculated to assess the degree of uniformity within the region. Prone position was applied immediately after the baseline data were collected. After 2 hours of proning, another EIT examination was conducted. Parameters such as DeadSpace, shunt, VQmatch, and other common measurements before and after pronation were taken and compared to evaluate the effect of prone positioning on CARDS and non-CARDS patients.

• Study Type: Observational
• Enrollment (Actual): 29

Contacts and Locations

Study Locations

• China
  • Beijing
    • Beijing, Beijing, China, 100730
      • PUMC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population includes COVID19-associated ARDS patients and ARDS patients of other etiologies in the intensive care unit.

Description

Inclusion Criteria:

• Above the age of 18
• Diagnosed with ARDS based on the Berlin Definition of ARDS
• Under mechanical ventilation

Exclusion Criteria:

• Contraindications to EIT examination and prone position
• Refusal of signing the informed consent

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
COVID19-associated ARDS (CARDS); This group included COVID19 patients with acute respiratory distress syndrome. Patients were put under prone position while their pulmonary function was measured using EIT before and after proning.
Non-COVID19-associated ARDS (non-CARDS); This group included patients with acute respiratory distress syndrome from other etiologies. Patients were put under prone position while their pulmonary function was measured using EIT before and after proning.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
DeadSpace	The area of Deadspace will be assessed using electrical impedance tomography	3 months
Shunt	Shunt will be assessed using electrical impedance tomography	3 months
Ventilation-perfusion matching (VQmatch)	VQmatch will be assessed using electrical impedance tomography	3 months
Global inhomogeneity index (VQmatch-GI)	Within the defined VQmatch region assessed by electrical impedance tomography, the global inhomogeneity index (VQmatch-GI) was calculated to assess the degree of uniformity within the region.	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Ventilation	The ventilation of the lungs is assessed by electrical impedance tomography before and after prone positioning.	3 months
Perfusion	The perfusion of the lungs is assessed by electrical impedance tomography before and after prone positioning.	3 months
Center of Ventilation (CoV)	The center of ventilation of the lungs is assessed by electrical impedance tomography before and after prone positioning.	3 months
Standard deviation of regional ventilation delay	The standard deviation of regional ventilation delay of the lungs is assessed by electrical impedance tomography before and after prone positioning.	3 months

Collaborators and Investigators

• Sponsor: Peking Union Medical College Hospital
• Investigators: Principal Investigator: Yun Long, MD, Peking Union Medical College

Study record dates

Study Major Dates

• Study Start (Actual): January 12, 2021
• Primary Completion (Actual): April 12, 2021
• Study Completion (Actual): April 12, 2021

Study Registration Dates

• First Submitted: April 5, 2023
• First Submitted That Met QC Criteria: April 17, 2023
• First Posted (Actual): April 18, 2023

Study Record Updates

• Last Update Posted (Actual): April 18, 2023
• Last Update Submitted That Met QC Criteria: April 17, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Keywords: ICU; COVID19; Acute Respiratory Distress Syndrome; Electrical impedance tomography
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Respiration Disorders; Lung Diseases; Infant, Newborn, Diseases; Lung Injury; Infant, Premature, Diseases; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Acute Lung Injury
• Other Study ID Numbers: EIT20230403

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No