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Master Thesis

Facteurs prédictifs de réponse au décubitus ventral chez les patients atteints d’un Syndrome de détresse respiratoire aiguë sévère lié à la Covid-19

Abstract : Background : Effects of prone positioning (PP) on blood oxygenation and survival are now established in severe forms of Acute Respiratory Distress Syndrome (ARDS) . Covid-19 induced ARDS presents some unusual characteristics compared to common ARDS. Purpose : Determine predictors of response to PP in Covid-19 ARDS. Investigate association between response and day-60 mortality Design : Prospective monocentric study in Bichat-Claude-Bernard Hospital Medical ICU. Patients : 43 patients with severe Covid-19 induced ARDS (PaO2/FiO2 ratio < 150 mmHg). Methods : Clinical characteristics, blood gas analysis and respiratory mechanics were analyzed at admission and each PP sessions. Response was defined as [(PaO2/FiO2 after PP – PaO2/FiO2 before PP)/ PaO2/FiO2 before PP] X 100. A negative binomial mixed model was used to evaluate predictors of response. Results : Median response in the 137 examined sessions was 46.96% [8.22;125.7], decreasing along sessions. High SAPS II and extra-respiratory SOFA score decreased response, while obesity, low viral load and a 25 to 30 ml/cmH2O respiratory compliance at session day (Crs) increased it. Obesity was an independent factor of high response (RR=1.27[1.06 ;1.52], p=0.009), and Crs < 25 ml/cmH2O of poor response (RR 0.79[0.67 ;0.94]; p=0.007). Day-60 mortality was 77.4%, not associated with response. Conclusion: In Covid-19 induced ARDS, obesity increases response to PP, while a severely altered respiratory compliance worsens it. Response is not associated with day-60 survival.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03426407
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Submitted on : Friday, November 12, 2021 - 11:26:55 AM
Last modification on : Tuesday, November 30, 2021 - 3:29:48 AM
Long-term archiving on: : Sunday, February 13, 2022 - 6:51:56 PM

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Matthieu Gabenesch. Facteurs prédictifs de réponse au décubitus ventral chez les patients atteints d’un Syndrome de détresse respiratoire aiguë sévère lié à la Covid-19. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03426407⟩

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