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Proning reduces ventilation heterogeneity in patients with elevated BMI: implications for COVID-19 pneumonia management?

Brody H. Foy, Christopher E. Brightling, Salman Siddiqui
ERJ Open Research 2020 6: 00292-2020; DOI: 10.1183/23120541.00292-2020
Brody H. Foy
1Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
2Dept of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Christopher E. Brightling
3National Institute for Health Research (NIHR), Leicester Biomedical Research Centre (Respiratory theme) and College of Life Sciences, University of Leicester, Leicester, UK
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Salman Siddiqui
3National Institute for Health Research (NIHR), Leicester Biomedical Research Centre (Respiratory theme) and College of Life Sciences, University of Leicester, Leicester, UK
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  • For correspondence: ss338@le.ac.uk
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    FIGURE 1

    Comparative ventilation heterogeneity between supine and prone positions, stratified by body mass index (BMI). a) Ventilation improvement (percentage reduction in alveolar volume variance at peak inhalation) when moved from supine to prone is given for 31 patient-based lung structures, with b) a clear and statistically significant (*) ventilation improvement in obese compared with non-obese patients. c) Average inspiratory lung volume for 10 slices (from dorsal to ventral), with standard deviation of volumes, for high- and low-BMI patients. d) Ventilation maps in supine and prone positions in two patients. Brighter colours indicate increased ventilation. When moving from supine to prone, the low-BMI patient experiences a significant reversal in volume distribution, while the high-BMI patient experiences a flattening out of the volume distribution, suggesting reduced ventilation heterogeneity. Ventilation maps were created by calculating the average ventilation ratio per voxel, in an 80-80-80 grid overlaid on each structure. Each image is the average of 10 central voxels in the vertical axis.

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Proning reduces ventilation heterogeneity in patients with elevated BMI: implications for COVID-19 pneumonia management?
Brody H. Foy, Christopher E. Brightling, Salman Siddiqui
ERJ Open Research Apr 2020, 6 (2) 00292-2020; DOI: 10.1183/23120541.00292-2020

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Proning reduces ventilation heterogeneity in patients with elevated BMI: implications for COVID-19 pneumonia management?
Brody H. Foy, Christopher E. Brightling, Salman Siddiqui
ERJ Open Research Apr 2020, 6 (2) 00292-2020; DOI: 10.1183/23120541.00292-2020
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