Respostas hemodinâmicas e ventilatórias durante postura Fowler modificada em obesos com COVID-19 sob ventilação mecânica. Série de casos / Hemodynamic and ventilatory responses during modified Fowler posture in obese patients with COVID-19 under mechanical ventilation. Case series

Abstract

Severe hypoxia in patients with COVID-19 has revived the use of positioning as a tool to optimize in mechanical ventilation. The Fowler posture is an option to the prone position, but there are questions about the degree of dorsal elevation and extension of the lower limbs, especially in obese patients. Objective: Present the Fowler's modification in monitoring obese patients on mechanical ventilation with COVID-19. Method: Series of 10 cases (6 women) with mean age (47.30±16.65 years), body mass index (41.76±8.25 kg/m²), under mechanical ventilation and with pulmonary involvement (61%±14.49) assessed on tomography. All patients had severe disease, with 60% dying. The average length of stay was 37.90±28.26 days and symptoms until intubation had an average of 12.30±8 days. All were positioned in the modified Fowler position with an elevated decubitus position (greater than 70°), external hip rotation and knee flexion to distribute the weight over the perineum. Arterial blood gas analysis was collected before and 120 minutes after positioning, in addition to monitoring clinical variables. Results: There was an increase in peripheral oxygen saturation (SpO₂) in the comparison between pre-positioning and 10 and 60 minutes after (p<0.05). The PaO₂/FiO₂ ratio increased by 20%. Conclusion: The modified Fowler position was associated with an increase in SpO₂ and PaO₂/FiO₂ ratio without hemodynamic changes or ventilatory.