{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T17:09:33Z","timestamp":1770743373796,"version":"3.49.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T00:00:00Z","timestamp":1708473600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Hj\u00e4rt-Lungfonden","doi-asserted-by":"publisher","award":["20210061"],"award-info":[{"award-number":["20210061"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009741","name":"David och Astrid Hagel\u00e9ns Stiftelse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009741","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003793","name":"Hj\u00e4rt-Lungfonden","doi-asserted-by":"publisher","award":["20210061"],"award-info":[{"award-number":["20210061"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The effects of awake prone positioning (APP) on respiratory mechanics in patients with COVID-19 are not well characterized. The aim of this study was to investigate changes of global and regional lung volumes during APP compared with the supine position using electrical lung impedance tomography (EIT) in patients with hypoxemic respiratory failure due to COVID-19.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>This exploratory non-randomized cross-over study was conducted at two university hospitals in Sweden between January and May 2021. Patients admitted to the intensive care unit with confirmed COVID-19, an arterial cannula in place, a PaO<jats:sub>2<\/jats:sub>\/FiO<jats:sub>2<\/jats:sub> ratio &lt;26.6 kPa (&lt;200 mmHg) and high-flow nasal oxygen or non-invasive ventilation were eligible for inclusion. EIT-data were recorded at supine baseline, at 30 and 60 minutes after APP-initiation, and 30 minutes after supine repositioning. The primary outcomes were changes in global and regional tidal impedance variation (TIV), center of ventilation (CoV), global and regional delta end-expiratory lung-impedance (dEELI) and global inhomogeneity (GI) index at the end of APP compared with supine baseline. Data were reported as median (IQR).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>All patients (n = 10) were male and age was 64 (47\u201373) years. There were no changes in global or regional TIV, CoV or GI-index during the intervention. dEELI increased from supine reference value 0 to 1.51 (0.32\u20133.62) 60 minutes after APP (median difference 1.51 (95% CI 0.19\u20135.16), p = 0.04) and returned to near baseline values after supine repositioning. Seven patients (70%) showed an increase &gt;0.20 in dEELI during APP. The other EIT-variables did not change during APP compared with baseline.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Awake prone positioning was associated with a transient lung recruiting effect without changes in ventilation distribution measured with EIT in patients with hypoxemic respiratory failure due to COVID-19.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0299199","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T18:29:26Z","timestamp":1708540166000},"page":"e0299199","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Lung impedance changes during awake prone positioning in COVID-19. A non-randomized cross-over study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9518-5834","authenticated-orcid":true,"given":"Jacob","family":"Ros\u00e9n","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Frykholm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malin","family":"Jonsson Fagerlund","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariangela","family":"Pellegrini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Campoccia Jalde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"von Oelreich","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diddi","family":"Fors","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,2,21]]},"reference":[{"key":"pone.0299199.ref001","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/acem.13994","article-title":"Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED\u2019s Experience During the COVID-19 Pandemic","volume":"27","author":"ND Caputo","year":"2020","journal-title":"Acad Emerg Med"},{"key":"pone.0299199.ref002","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/S2213-2600(20)30268-X","article-title":"Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study","volume":"8","author":"A Coppo","year":"2020","journal-title":"Lancet Respir Med"},{"key":"pone.0299199.ref003","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1164\/rccm.202004-1331LE","article-title":"Prone Positioning of Nonintubated Patients with COVID-19","volume":"202","author":"M Damarla","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0299199.ref004","first-page":"24","article-title":"Prone positioning combined with high-flow nasal or conventional oxygen therapy in severe Covid-19 patients","author":"C Despres","year":"2020","journal-title":"Crit Care"},{"key":"pone.0299199.ref005","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/S2213-2600(21)00356-8","article-title":"Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial","volume":"9","author":"S Ehrmann","year":"2021","journal-title":"Lancet Respir Med"},{"key":"pone.0299199.ref006","doi-asserted-by":"crossref","first-page":"e071966","DOI":"10.1136\/bmj-2022-071966","article-title":"Efficacy of awake prone positioning in patients with covid-19 related hypoxemic respiratory failure: systematic review and meta-analysis of randomized trials","volume":"379","author":"J Weatherald","year":"2022","journal-title":"BMJ"},{"key":"pone.0299199.ref007","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/S2213-2600(22)00043-1","article-title":"Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis","volume":"10","author":"J Li","year":"2022","journal-title":"Lancet Respir Med"},{"key":"pone.0299199.ref008","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1177\/08850666221081757","article-title":"Predicting Impact of Prone Position on Oxygenation in Mechanically Ventilated Patients with COVID-19","volume":"37","author":"J Bell","year":"2022","journal-title":"J Intensive Care Med"},{"key":"pone.0299199.ref009","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1164\/rccm.201311-2056LE","article-title":"Proseva Investigators. Prone position-induced improvement in gas exchange does not predict improved survival in the acute respiratory distress syndrome","volume":"189","author":"RK Albert","year":"2014","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0299199.ref010","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s13054-022-03950-0","article-title":"Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure: analysis of a randomized controlled trial","volume":"26","author":"M Ibarra-Estrada","year":"2022","journal-title":"Crit Care Lond Engl"},{"key":"pone.0299199.ref011","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1007\/s00134-020-06306-w","article-title":"Prone position in ARDS patients: why, when, how and for whom","volume":"46","author":"C Gu\u00e9rin","year":"2020","journal-title":"Intensive Care Med"},{"key":"pone.0299199.ref012","doi-asserted-by":"crossref","first-page":"210022","DOI":"10.1183\/16000617.0022-2021","article-title":"Awake prone positioning for hypoxaemic respiratory failure: past, COVID-19 and perspectives","volume":"30","author":"F Touchon","year":"2021","journal-title":"Eur Respir Rev Off J Eur Respir Soc"},{"key":"pone.0299199.ref013","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1164\/rccm.202008-3044IM","article-title":"Lung Recruiting Effect of Prone Positioning in Spontaneously Breathing Patients with COVID-19 Assessed by Electrical Impedance Tomography","volume":"204","author":"Y Brunin","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0299199.ref014","doi-asserted-by":"crossref","first-page":"11085","DOI":"10.1038\/s41598-022-15122-9","article-title":"Effect of body position on the redistribution of regional lung aeration during invasive and non-invasive ventilation of COVID-19 patients","volume":"12","author":"A Dos Santos Rocha","year":"2022","journal-title":"Sci Rep"},{"key":"pone.0299199.ref015","article-title":"Regional ventilation in spontaneously breathing COVID-19 patients during postural maneuvers assessed by electrical impedance tomography","author":"A Zitzmann","journal-title":"Acta Anaesthesiol Scand"},{"key":"pone.0299199.ref016","first-page":"9","article-title":"Awake prone position in COVID-19 acute respiratory failure: a randomised crossover study using electrical impedance tomography","author":"T Brunelle","year":"2023","journal-title":"ERJ Open Res"},{"key":"pone.0299199.ref017","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/s13054-023-04600-9","article-title":"Physiological effects of awake prone position in acute hypoxemic respiratory failure","volume":"27","author":"DL Grieco","year":"2023","journal-title":"Crit Care"},{"key":"pone.0299199.ref018","doi-asserted-by":"crossref","first-page":"728243","DOI":"10.3389\/fphys.2021.728243","article-title":"A Pilot Study on Electrical Impedance Tomography During CPAP Trial in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: The Bright Side of Non-invasive Ventilation","volume":"12","author":"M Rauseo","year":"2021","journal-title":"Front Physiol"},{"key":"pone.0299199.ref019","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1136\/thoraxjnl-2016-208357","article-title":"Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group","volume":"72","author":"I Frerichs","year":"2017","journal-title":"Thorax"},{"key":"pone.0299199.ref020","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1186\/s13054-018-2195-6","article-title":"Electrical impedance tomography in acute respiratory distress syndrome","volume":"22","author":"MC Bachmann","year":"2018","journal-title":"Crit Care Lond Engl"},{"key":"pone.0299199.ref021","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1378\/chest.124.1.314","article-title":"Regional ventilation by electrical impedance tomography: a comparison with ventilation scintigraphy in pigs","volume":"124","author":"J Hinz","year":"2003","journal-title":"Chest"},{"key":"pone.0299199.ref022","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s10877-006-9021-4","article-title":"Electrical impedance tomography\u2019s correlation to lung volume is not influenced by anthropometric parameters","volume":"20","author":"F Marquis","year":"2006","journal-title":"J Clin Monit Comput"},{"key":"pone.0299199.ref023","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1164\/rccm.200301-133OC","article-title":"Imbalances in Regional Lung Ventilation","volume":"169","author":"JA Victorino","year":"2004","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0299199.ref024","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1109\/TMI.2002.800585","article-title":"Regional lung perfusion as determined by electrical impedance tomography in comparison with electron beam CT imaging","volume":"21","author":"I Frerichs","year":"2002","journal-title":"IEEE Trans Med Imaging"},{"key":"pone.0299199.ref025","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1097\/CCM.0B013E3181652EDD","article-title":"Electrical impedance tomography compared with thoracic computed tomography during a slow inflation maneuver in experimental models of lung injury*","volume":"36","author":"H Wrigge","year":"2008","journal-title":"Crit Care Med"},{"key":"pone.0299199.ref026","doi-asserted-by":"crossref","first-page":"R82","DOI":"10.1186\/cc7900","article-title":"Electrical impedance tomography compared to positron emission tomography for the measurement of regional lung ventilation: an experimental study","volume":"13","author":"JC Richard","year":"2009","journal-title":"Crit Care Lond Engl"},{"key":"pone.0299199.ref027","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00134-002-1555-4","article-title":"End-expiratory lung impedance change enables bedside monitoring of end-expiratory lung volume change","volume":"29","author":"J Hinz","year":"2003","journal-title":"Intensive Care Med"},{"key":"pone.0299199.ref028","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1186\/s13054-021-03602-9","article-title":"Awake prone positioning in patients with hypoxemic respiratory failure due to COVID-19: the PROFLO multicenter randomized clinical trial","volume":"25","author":"J Ros\u00e9n","year":"2021","journal-title":"Crit Care"},{"key":"pone.0299199.ref029","first-page":"1762","article-title":"Monitoring changes in lung air and liquid volumes with electrical impedance tomography","volume":"83","author":"A Adler","year":"1997","journal-title":"J Appl Physiol Bethesda Md 1985"},{"key":"pone.0299199.ref030","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/j.1399-6576.1998.tb05308.x","article-title":"Monitoring perioperative changes in distribution of pulmonary ventilation by functional electrical impedance tomography","volume":"42","author":"I Frerichs","year":"1998","journal-title":"Acta Anaesthesiol Scand"},{"key":"pone.0299199.ref031","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1164\/rccm.200512-1942OC","article-title":"Lung Volume Recruitment after Surfactant Administration Modifies Spatial Distribution of Ventilation","volume":"174","author":"I Frerichs","year":"2006","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0299199.ref032","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1007\/s00134-009-1589-y","article-title":"Evaluation of an electrical impedance tomography-based global inhomogeneity index for pulmonary ventilation distribution","volume":"35","author":"Z Zhao","year":"2009","journal-title":"Intensive Care Med"},{"key":"pone.0299199.ref033","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/1756-0500-7-82","article-title":"The EIT-based global inhomogeneity index is highly correlated with regional lung opening in patients with acute respiratory distress syndrome","volume":"7","author":"Z Zhao","year":"2014","journal-title":"BMC Res Notes"},{"key":"pone.0299199.ref034","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.bja.2021.09.031","article-title":"Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis","volume":"128","author":"B Fazzini","year":"2022","journal-title":"Br J Anaesth"},{"key":"pone.0299199.ref035","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1097\/CCM.0000000000005450","article-title":"Effects of Prone Position on Lung Recruitment and Ventilation-Perfusion Matching in Patients With COVID-19 Acute Respiratory Distress Syndrome: A Combined CT Scan\/Electrical Impedance Tomography Study*","volume":"50","author":"T Fossali","year":"2022","journal-title":"Crit Care Med"},{"key":"pone.0299199.ref036","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1183\/09031936.00037014","article-title":"Gas exchange and ventilation-perfusion relationships in the lung","volume":"44","author":"J Petersson","year":"2014","journal-title":"Eur Respir J"},{"key":"pone.0299199.ref037","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s13054-022-04021-0","article-title":"Prone positioning improves ventilation-perfusion matching assessed by electrical impedance tomography in patients with ARDS: a prospective physiological study","volume":"26","author":"Y-X Wang","year":"2022","journal-title":"Crit Care Lond Engl"},{"key":"pone.0299199.ref038","doi-asserted-by":"crossref","first-page":"S280","DOI":"10.1513\/AnnalsATS.201704-343OT","article-title":"Prone Position for Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis","volume":"14","author":"L Munshi","year":"2017","journal-title":"Ann Am Thorac Soc"},{"key":"pone.0299199.ref039","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1186\/s13613-021-00967-6","article-title":"Awake prone position reduces work of breathing in patients with COVID-19 ARDS supported by CPAP","volume":"11","author":"D Chiumello","year":"2021","journal-title":"Ann Intensive Care"},{"key":"pone.0299199.ref040","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1007\/s00134-020-05942-6","article-title":"Respiratory drive in the acute respiratory distress syndrome: pathophysiology, monitoring, and therapeutic interventions","volume":"46","author":"E Spinelli","year":"2020","journal-title":"Intensive Care Med"},{"key":"pone.0299199.ref041","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1164\/rccm.202110-2360LE","article-title":"Effects of Trunk Inclination on Respiratory Mechanics in Patients with COVID-19\u2013associated Acute Respiratory Distress Syndrome: Let\u2019s Always Report the Angle!","volume":"205","author":"F Marrazzo","year":"2022","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0299199.ref042","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1007\/s00134-013-2827-x","article-title":"Effect of different seated positions on lung volume and oxygenation in acute respiratory distress syndrome","volume":"39","author":"J Dellamonica","year":"2013","journal-title":"Intensive Care Med"},{"key":"pone.0299199.ref043","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/s00134-018-5493-1","article-title":"Effect of body position and inclination in supine and prone position on respiratory mechanics in acute respiratory distress syndrome","volume":"45","author":"M Mezidi","year":"2019","journal-title":"Intensive Care Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0299199","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T18:29:57Z","timestamp":1708540197000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0299199"}},"subtitle":[],"editor":[{"given":"Jean Baptiste","family":"Lascarrou","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,2,21]]},"references-count":43,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0299199","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,21]]}}}