Prone positioning improves ventilation-perfusion matching assessed by electrical impedance tomography in patients with ARDS: a prospective physiological study

Yu-Xian Wang, Ming Zhong, Min-Hui Dong, Jie-Qiong Song, Yi-Jun Zheng, Wei Wu, Jia-le Tao, Ling Zhu, Xin Zheng, Yu-Xian Wang, Ming Zhong, Min-Hui Dong, Jie-Qiong Song, Yi-Jun Zheng, Wei Wu, Jia-le Tao, Ling Zhu, Xin Zheng

Abstract

Background: The physiological effects of prone ventilation in ARDS patients have been discussed for a long time but have not been fully elucidated. Electrical impedance tomography (EIT) has emerged as a tool for bedside monitoring of pulmonary ventilation and perfusion, allowing the opportunity to obtain data. This study aimed to investigate the effect of prone positioning (PP) on ventilation-perfusion matching by contrast-enhanced EIT in patients with ARDS.

Design: Monocenter prospective physiologic study.

Setting: University medical ICU.

Patients: Ten mechanically ventilated ARDS patients who underwent PP.

Interventions: We performed EIT evaluation at the initiation of PP, 3 h after PP initiation and the end of PP during the first PP session.

Measurements and main results: The regional distribution of ventilation and perfusion was analyzed based on EIT images and compared to the clinical variables regarding respiratory and hemodynamic status. Prolonged prone ventilation improved oxygenation in the ARDS patients. Based on EIT measurements, the distribution of ventilation was homogenized and dorsal lung ventilation was significantly improved by PP administration, while the effect of PP on lung perfusion was relatively mild, with increased dorsal lung perfusion observed. The ventilation-perfusion matched region was found to increase and correlate with the increased PaO2/FiO2 by PP, which was attributed mainly to reduced shunt in the lung.

Conclusions: Prolonged prone ventilation increased dorsal ventilation and perfusion, which resulted in improved ventilation-perfusion matching and oxygenation.

Trial registration: ClinicalTrials.gov, NCT04725227. Registered on 25 January 2021.

Keywords: Acute respiratory distress syndrome; Electrical impedance tomography; Mechanical ventilation; Prone positioning; Pulmonary perfusion; Ventilation–perfusion matching.

Conflict of interest statement

The authors have no potential conflicts of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Effects of prone position on ventilation–perfusion matching in a representative study patient. Left: performed in the supine (T0), Middle: 3 h after PP initiation (T1), Right: at the end of PP (T2). During prone ventilation, pulmonary blood flow is mostly unmodified at the early stage and then gradually changes over time. Long prone ventilation increases dorsal ventilation and perfusion, which results in improved ventilation–perfusion matching
Fig. 2
Fig. 2
Evolution of Tidal image region (%) (A), Blood flow region (%) (C), ventilation (B) or perfusion distribution (%) (D) in the horizontal regions of interest (ROIs) at T0, T1, and T2. *vs. T0, p < 0.05. #vs. T1, p < 0.05
Fig. 3
Fig. 3
Comparisons of Matched Region (%) (A), Shunt-EIT (%) (B), and Dead Space-EIT (%) (C) at T0, T1, and T2. *p < 0.05. PaO2/FiO2 was significantly correlated with Matched Region (%) (D) and Shunt-EIT (%) (E), but not with Dead Space-EIT(%) (F)

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