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Background <p>ARDS is a heterogeneous syndrome involving different subphenotypes with different clinical features and different responses to treatment strategies. The prone position (PP) is an effective treatment for ARDS; however, whether the effects of prone positioning vary among ARDS patients with different subphenotypes remains unknown.</p> Objectives <p>To evaluated the impact of PP on ventilation-perfusion matching(VQ matching) by contrast-enhanced Electrical impedance tomography (EIT) in ARDS patients with different subphenotypes.</p> Methods <p>This was a prospective, observational study at the medical ICU of Zhongda Hospital, Southeast University. ARDS patients undergoing mechanical ventilation were screened and allocated to different subphenotypes based on lung morphology (focal/non-focal) and D-dimer level (low/high D-dimer). EIT was used in the supine position and 3&#xa0;h, 6&#xa0;h, and 12&#xa0;h after the PP during the first PP session.</p> Results <p>From July 1, 2021, to July 1, 2022, 25 patients were included in this study. 10 patients (40%) were focal ARDS, and 15 were non-focal ARDS based on baseline morphology. 12 patients (48%) were high D-dimer ARDS, and 13 were low D-dimer ARDS based on baseline D-dimer levels. PaO2/FiO2 increased significantly 3&#xa0;h after prone positioning in focal ARDS patients (130.30[109.94–147.30] vs. 213.50[176.00-256.50] mmHg, <i>p</i> &lt; 0.001), while the effect of improved oxygenation was not apparent until 6&#xa0;h after prone positioning in non-focal ARDS patients (104.60[95.20–127.00] vs. 190.20[160.10-213.20] mm Hg, <i>p</i> &lt; 0.001). VQ matching improved after 3&#xa0;h in the prone position in the focal ARDS group (69.93 ± 6.69 vs. 78.22 ± 5.07, <i>p</i> = 0.006) but improved after only 6&#xa0;h in the prone position in the non-focal ARDS group (67.32 ± 4.78 vs. 78.70 ± 5.93, <i>p</i> &lt; 0.001). In ARDS patients with varying levels of D-dimer, increased PaO2/FiO2 (126.60[99.30-146.20] vs. 185.20[112.10–236.00] mmHg, <i>p</i> = 0.013) and improved VQ matching (67.60 ± 4.60 vs. 72.97 ± 6.48, <i>p</i> = 0.023) were observed at 3&#xa0;h in the PP in patients with low D-dimer ARDS. In contrast, increased PaO2/FiO2(105.20[95.20-124.10] vs. 195.2[183.20-213.20], <i>p</i> &lt; 0.001) and improved VQ matching (67.19 ± 6.70 vs. 72.50 ± 6.37, <i>p</i> &lt; 0.001) were revealed only after 6&#xa0;h in the prone position in high D-dimer ARDS patients.</p> Conclusions <p>For moderate to severe ARDS patients, non-focal and high D-dimer ARDS patients need longer PP to improve oxygenation and VQmatching than the focal and low D-dimer patients.</p> Clinical Trial Registration <p>This was a prospective, observational study registered in the Chinese Clinical Trial Registry (ChiCTR2200055442, <a href="https://www.chictr.org.cn/">https://www.chictr.org.cn/</a>), on June 30, 2021.</p>

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Effect of prone position on ventilation-perfusion matching in patients with moderate to severe ARDS with different clinical phenotypes

  • 期刊论文

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  • 发表日期：

    2025年2月28日

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  • Shuhe Yang,
  • Qin Sun,
  • Xueyan Yuan,
  • Jinlong Wang,
  • Haofei Wang,
  • Wenhan Hu,
  • Qingyun Peng,
  • Chen Zhang,
  • Xiangquan Li,
  • Wei Huang,
  • Jianfeng Xie,
  • Fengmei Guo,
  • Ling Liu,
  • Yi Yang,
  • Yingzi Huang

摘要

Background

ARDS is a heterogeneous syndrome involving different subphenotypes with different clinical features and different responses to treatment strategies. The prone position (PP) is an effective treatment for ARDS; however, whether the effects of prone positioning vary among ARDS patients with different subphenotypes remains unknown.

Objectives

To evaluated the impact of PP on ventilation-perfusion matching(VQ matching) by contrast-enhanced Electrical impedance tomography (EIT) in ARDS patients with different subphenotypes.

Methods

This was a prospective, observational study at the medical ICU of Zhongda Hospital, Southeast University. ARDS patients undergoing mechanical ventilation were screened and allocated to different subphenotypes based on lung morphology (focal/non-focal) and D-dimer level (low/high D-dimer). EIT was used in the supine position and 3 h, 6 h, and 12 h after the PP during the first PP session.

Results

From July 1, 2021, to July 1, 2022, 25 patients were included in this study. 10 patients (40%) were focal ARDS, and 15 were non-focal ARDS based on baseline morphology. 12 patients (48%) were high D-dimer ARDS, and 13 were low D-dimer ARDS based on baseline D-dimer levels. PaO2/FiO2 increased significantly 3 h after prone positioning in focal ARDS patients (130.30[109.94–147.30] vs. 213.50[176.00-256.50] mmHg, p < 0.001), while the effect of improved oxygenation was not apparent until 6 h after prone positioning in non-focal ARDS patients (104.60[95.20–127.00] vs. 190.20[160.10-213.20] mm Hg, p < 0.001). VQ matching improved after 3 h in the prone position in the focal ARDS group (69.93 ± 6.69 vs. 78.22 ± 5.07, p = 0.006) but improved after only 6 h in the prone position in the non-focal ARDS group (67.32 ± 4.78 vs. 78.70 ± 5.93, p < 0.001). In ARDS patients with varying levels of D-dimer, increased PaO2/FiO2 (126.60[99.30-146.20] vs. 185.20[112.10–236.00] mmHg, p = 0.013) and improved VQ matching (67.60 ± 4.60 vs. 72.97 ± 6.48, p = 0.023) were observed at 3 h in the PP in patients with low D-dimer ARDS. In contrast, increased PaO2/FiO2(105.20[95.20-124.10] vs. 195.2[183.20-213.20], p < 0.001) and improved VQ matching (67.19 ± 6.70 vs. 72.50 ± 6.37, p < 0.001) were revealed only after 6 h in the prone position in high D-dimer ARDS patients.

Conclusions

For moderate to severe ARDS patients, non-focal and high D-dimer ARDS patients need longer PP to improve oxygenation and VQmatching than the focal and low D-dimer patients.

Clinical Trial Registration

This was a prospective, observational study registered in the Chinese Clinical Trial Registry (ChiCTR2200055442, https://www.chictr.org.cn/), on June 30, 2021.