ArticleJournal of intensive care2026
EIT-assessed ventilation-perfusion responses to prone positioning and inhaled nitric oxide in mechanically ventilated COVID-19-related ARDS: a prospective sequential study.
Article in Journal of intensive care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05715762 (Determine the Effects of Prone Positioning and Nitric Oxide in Adult COVID-19 Patients With ARDS by Electrical Impedance Tomography), which is not on this map. Not yet cited in PubMed.
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Determine the Effects of Prone Positioning and Nitric Oxide in Adult COVID-19 Patients With ARDS by Electrical Impedance Tomography
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8 authors.
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Abstract
backgroundProne positioning (PP) and inhaled nitric oxide (iNO) are widely utilized rescue therapies for severe hypoxemia during invasive mechanical ventilation. However, their combined effects on regional ventilation-perfusion (V/Q) matching remain incompletely characterized. This study utilized single-plane saline-contrast electrical impedance tomography (EIT) to achieve real-time bedside visualization and evaluate the relative spatial mechanisms of these interventions in patients with COVID-19-related ARDS.
methodsWe conducted a prospective sequential physiological study in mechanically ventilated patients with moderate-to-severe COVID-19-related acute respiratory distress syndrome (ARDS). Relative regional ventilation, perfusion, and V/Q matching distributions were monitored across four predefined, fixed sequential conditions: supine position ventilation (SPV), SPV with iNO (20 ppm for 1 h; SPV + iNO), prone position ventilation after stabilization (PPV), and PPV with an additional 1 h of iNO (PPV + iNO). Primary analyses focused on prespecified within-patient contrasts, supplemented by exploratory difference-in-differences (DiD) analyses to evaluate position-dependent vascular responses.
resultsTwenty-eight patients completed all study phases. Hemodynamics and conventional respiratory mechanics remained remarkably stable across all four conditions. Systemic oxygenation improved progressively; both SPV + iNO and PPV significantly increased PaO
conclusionsBoth prone positioning and iNO improved oxygenation in moderate-to-severe COVID-19-related ARDS. Within the EIT-assessed thoracic slice, these improvements were accompanied by better regional V/Q matching, which was mainly perfusion-related rather than ventilation-related and suggests limited recruitability of the imaged region; the effect of iNO on regional V/Q matching was attenuated in the prone position. As EIT samples a single thoracic cross-section, these are localized findings and should not be generalized to the whole lung. Trial registration ClinicalTrials.gov, NCT05715762. Registered 08 February 2023.
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