Gulseren Yilmaz1, *, 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.
Covid-19, acute respiratory distress syndrome, beach chair position, lung compliance.