Patients receiving mechanical ventilation for coronavirus disease 2019 (COVID-19) related, moderate-to-severe acute respiratory distress syndrome (CARDS) have mortality rates between 76–98%. The objective of this retrospective cohort study was to identify differences in prone ventilation effects on oxygenation, pulmonary infiltrates (as observed on chest X-ray (CXR)), and systemic inflammation in CARDS patients by survivorship and to identify baseline characteristics associated with survival after prone ventilation. The study cohort included 23 patients with moderate-to-severe CARDS who received prone ventilation for ≥16 h/day and was segmented by living status: living ( n = 6) and deceased ( n = 17). Immediately after prone ventilation, PaO 2 /FiO 2 improved by 108% ( p < 0.03) for the living and 150% ( p < 3 × 10 −4 ) for the deceased. However, the 48 h change in lung infiltrate severity in gravity-dependent lung zones was significantly better for the living than for the deceased ( p < 0.02). In CXRs of the lower lungs before prone ventilation, we observed 5 patients with confluent infiltrates bilaterally, 12 patients with ground-glass opacities (GGOs) bilaterally, and 6 patients with mixed infiltrate patterns; 80% of patients with confluent infiltrates were alive vs. 8% of patients with GGOs. In conclusion, our small study indicates that CXRs may offer clinical utility in selecting patients with moderate-to-severe CARDS who will benefit from prone ventilation. Additionally, our study suggests that lung infiltrate severity may be a better indicator of patient disposition after prone ventilation than PaO 2 /FiO 2 .
【저자키워드】 Coronavirus disease 2019 (COVID-19), acute respiratory distress syndrome (ARDS), chest imaging, diagnostic radiology, prone positioning, Prone ventilation, severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), 【초록키워드】 COVID-19, coronavirus disease, mechanical ventilation, severity, lung, ground-glass opacity, survival, Patient, chest X-ray, systemic inflammation, mortality rate, survivorship, acute respiratory distress, Deceased, CXR, Oxygenation, retrospective cohort study, baseline characteristics, syndrome, clinical utility, zone, study cohort, GGOs, offer, Effect, benefit, identify, significantly, receiving, indicate, PaO, pulmonary infiltrate, 【제목키워드】 COVID-19, prone, respiratory, Effect, Infiltrate,