EFFECTS OF THE BEACH CHAIR POSITION ON RESPIRATORY FUNCTION IN COVID-19 PATIENTS

Gulseren Yilmaz^{1, *}, Engin Ihsan Turan¹, Ebru Kaya², Anil Berkay Balitatli¹, Gozde Kucuksarac¹, Alican Ruşen¹, MehmetKocadag¹, Uygar Ozan Atmaca¹, Emirhan Kahraman¹, Mikail Akin¹, Aziz Ocakoglu³, Naime Yalcin¹, Ayça Sultan Şahin¹, Baris Sandal⁴, Ziya Salihoglu⁵

¹Department of Anesthesiology & Reanimation, University of Health Sciences, Faculty of Medicine, Kanuni Sultan Suleyman Hospital, Istanbul, Turkey - ²Department of Intensive Care Unit, University of Health Sciences, Faculty of Medicine, Kanuni Sultan Suleyman Hospital, Istanbul, Turkey - ³Department of General Surgery, University of Health Sciences, Faculty of Medicine, Kanuni Sultan Suleyman Hospital, Istanbul, Turkey - ⁴Department of Radiology, University of Health Sciences, Faculty of Medicine, Kanuni Sultan Suleyman Hospital, Istanbul, Turkey - ⁵Department of Anesthesiology & Reanimation, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey

Introduction: Whether beach chair position can improve pulmonary compliance in mechanically ventilated subjects with Coronavirus disease 2019 (COVID-19) is unclear. This study aimed to investigate the impact of beach chair position on pulmonary compliance and oxygenation in mechanically ventilated patients with COVID-19.

Materials and methods: Forty-four COVID-19 subjects admitted to intensive care unit (ICU) of our institute who receive invasive mechanical ventilation were enrolled in this observational study. Patients were initially placed in supine position. Following a couple of hours patients were then placed in beach-chair position (head of bed elevated to 30 degrees) at least 16 hours a day. Data from mechanical ventilator was recorded hourly in each position. Total compliance was defined as tidal volume (VT, milliliters) divided by the difference between plateau pressure (cm H2O) and positive end-expiratory pressure (PEEP, cm H₂O) Blood gas analysis was performed bi-hourly. Mean values were taken for statistical analysis. The difference in lung compliance, airway resistance, and blood gas analysis between supine and beach chair position was the primary outcome measure of this study. 

Results: Positioning patients form supine to beach-chair led to a significant improvement in lung compliance (29.68±10.42 ml/cm H₂O vs. 33.96±11.71 ml/cm H₂O, p<0.001), reduction in airway resistance (17.51±8.44 H₂O/L/sc vs. 16.73±8.06 H₂O/L/sc, p<0.001) and led to a significant decline in plateau pressure (30.82±5.94 cm H₂O vs. 29.98±5.68 cm H₂O, p=0.001). Moreover a significant improvement in PaO₂ was observed following positioning from supine to beach-chair (67.93±20.29 mm Hg vs. 87.83±27.33 mm Hg, p<0.001).

Conclusions: Compared to supine position, beach chair positioning improves lung compliance and oxygenation in COVID-19 patients with acute respiratory distress syndrome (ARDS) who receive invasive mechanical ventilation.