Awake prone positioning (PP) reduces need for intubation for patients with COVID-19 with acute respiratory failure. We investigated the hemodynamic effects of awake PP in non-ventilated subjects with COVID-19 acute respiratory failure.
METHODS:
We conducted a single-center prospective cohort study. Adult hypoxemic subjects with COVID-19 not requiring invasive mechanical ventilation receiving at least one PP session were included. Hemodynamic assessment was done with transthoracic echocardiography before, during, and after a PP session.
RESULTS:
Twenty-six subjects were included. We observed a significant and reversible increase in cardiac index (CI) during PP compared to supine position (SP): 3.0 ± 0.8 L/min/m2 in PP, 2.5 ± 0.6 L/min/m2 before PP (SP1), and 2.6 ± 0.5 L/min/m2 after PP (SP2, P < .001). A significant improvement in right ventricular (RV) systolic function was also evidenced during PP: The RV fractional area change was 36 ± 10% in SP1, 46 ± 10% during PP, and 35 ± 8% in SP2 (P < .001). There was no significant difference in PaO2/FIO2 and breathing frequency.
CONCLUSION:
CI and RV systolic function are improved by awake PP in non-ventilated subjects with COVID-19 with acute respiratory failure.
Authors report 163 cases of lumbar sympathectomy they did under local anesthesia from 1968 to 1975. All were older--and poor risk patients. Approach was always lumbar with resection of distal part of the 12th rib. If good care is taken to do anesthesia infiltration of the five lower intercostal nerves and of the 1st and 2nd posterior lumbar nerves, anesthesia is quite good, and surgery easy and painless. The main advantages are:--easy excision of the first lumbar sympathetic node through this lumbar approach;--low lethality as far as authors consider almost no contra-indications;--very fast recovery of bowel movements;--immediate oral feeding which is important for diabetic patients;--no tracheal, bronchial or lung postoperative infestation or trouble. Patients have never had any trouble (convulsions) from lignocaine since gardenal is given in pre-anesthesia.
Cardiovascular system involvement and its negative prognostic impact have been increasingly identified in coronavirus disease 2019 (COVID-19) patients. Optimal medical treatment allows for safe management of most of these cardiovascular presentations while COVID-19-associated refractory cardiogenic shock could be rescued by veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We present a case of acute myocardial injury related to COVID-19 complicated by refractory cardiogenic shock and treated by VA-ECMO implantation.
