Prone Position in Mechanically Ventilated COVID-19 Patients: A Multicenter Study (original) (raw)
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Acta Anaesthesiologica Scandinavica, 2020
BackgroundThe management of COVID‐19 ARDS is debated. Although current evidence does not suggest an atypical acute respiratory distress syndrome (ARDS), the physiological response to prone positioning is not fully understood and it is unclear which patients benefit. We aimed to determine whether proning increases oxygenation and to evaluate responders.MethodsThis case series from a single, tertiary university hospital includes all mechanically ventilated patients with COVID‐19 and proning between 17 March 2020 and 19 May 2020. The primary measure was change in PaO2:FiO2.ResultsForty‐four patients, 32 males/12 females, were treated with proning for a total of 138 sessions, with median (range) two (1‐8) sessions. Median (IQR) time for the five sessions was 14 (12‐17) hours. In the first session, median (IQR) PaO2:FiO2 increased from 104 (86‐122) to 161 (127‐207) mm Hg (P < .001). 36/44 patients (82%) improved in PaO2:FiO2, with a significant increase in PaO2:FiO2 in the first three...
Journal of Clinical Medicine, 2021
Hypoxemia of the acute respiratory distress syndrome can be reduced by turning patients prone. Prone positioning (PP) is labor intensive, risks unplanned tracheal extubation, and can result in facial tissue injury. We retrospectively examined prolonged, repeated, and early versus later PP for 20 patients with COVID-19 respiratory failure. Blood gases and ventilator settings were collected before PP, at 1, 7, 12, 24, 32, and 39 h after PP, and 7 h after completion of PP. Analysis of variance was used for comparisons with baseline values at supine positions before turning prone. PP for >39 h maintained PaO2/FiO2 (P/F) ratios when turned supine; the P/F decrease at 7 h was not significant from the initial values when turned supine. Patients turned prone a second time, when again turned supine at 7 h, had significant decreased P/F. When PP started for an initial P/F ≤ 150 versus P/F > 150, the P/F increased throughout the PP and upon return to supine. Our results show that a singl...
Annals of Intensive Care
Background Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (≥ median PaO2/FiO2 variation) or non-responders (
Respiratory Parameters of COVID-19 Patients After the Prone Position
Nursing Current: Jurnal Keperawatan, 2021
Hypoxemia is a condition when there is a lack of oxygen levels in the blood, especially from the arteries. In the early stages of COVID-19, several mechanisms such as intrapulmonary shunting, loss of pulmonary perfusion regulation, intravascular micro thrombus, and impaired diffusion capacity can contribute to the development of arterial hypoxemia, although there is no increase in respiratory work. The prone position is one of the most widely used therapies for patients with hypoxemia because the dorsal area has a large number of alveolar units that are not compressed by the weight of the abdominal cavity and mediastinum, thus creating a more efficient area for gas exchange. This study aimed to determine the effect of the prone position on changes in respiratory parameters of COVID-19 patients. This study used the descriptive correlation method on 27 respondents with purposive sampling. Each respondent was given a prone position for three hours and being observed before, during the ...
Critical Care
Background Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. Methods Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced du...
Irish Journal of Medical Science (1971 -)
Background The benefits of prone positioning in acute respiratory distress syndrome (ARDS) have been known for many years. While some controversy exists regarding whether coronavirus disease 2019 (COVID-19) pneumonia should be treated with the same therapeutic strategies as for non-COVID ARDS, the Surviving Sepsis Campaign still provide a weak recommendation to utilise prone positioning in this setting. Aims The aims of this study are to ascertain if prone positioning improves oxygenation significantly in mechanically ventilated patients with severe COVID-19 ARDS and to describe the feasibility of frequent prone positioning in an Irish regional hospital intensive care unit (ICU) with limited prior experience. Methods In this retrospective, observational cohort study, we investigate if the PaO 2 /FiO 2 ratio and ventilatory ratio improve during and following prone positioning, and whether this improvement correlates with patient baseline characteristics or survival. Results Between March 2020 and 2021, 12 patients underwent prone positioning while mechanically ventilated for severe COVID ARDS. Sixty-six percent were male, mean age 60.9 (± 10.5), mean BMI 33.5 (± 6.74) and median APACHE II score on admission to ICU was 10.5 (7.25-16.3). Further, 83% were proned within 24 h of being intubated due to refractory hypoxaemia. PaO 2 /FiO 2 ratio improved from 11.6 kPa (9.80-13.8) to 15.80 kPa (13.1-19.6) while prone, p < 0.0001. Conclusions We found prone positioning to be a safe method of significantly improving oxygenation in mechanically ventilated patients with severe COVID-19 ARDS. We did not find a relationship between patient baseline characteristics nor illness severity and degree of PaO 2 /FiO 2 ratio improvement, nor did we find a relationship between degree of PaO 2 /FiO 2 ratio improvement and survival.
A REVIEW OF THE PRONE POSITION IN ACUTE RESPIRATORY FAILURE DUE TO COVID-19 (Atena Editora)
A REVIEW OF THE PRONE POSITION IN ACUTE RESPIRATORY FAILURE DUE TO COVID-19 (Atena Editora), 2023
To improve oxygenation, the prone position is indicated in acute respiratory distress syndrome, being used in critically ill patients. The use of prone position improves the hypoxemic level and reduces mortality when used early. The objective is to identify the indication and main benefits and complications of the prone position in patients admitted to the Intensive Care Unit under mechanical ventilation due to acute respiratory failure due to Covid-19. This is a narrative review of the literature carried out in August 2022, in the Scielo, PubMed and ``Portal de Periódicos Capes`` databases on the clinical indication, benefits and complications of the prone position in patients under mechanical ventilation due to acute respiratory failure due to Covid-19. 19, admitted to the Intensive Care Unit. The Health Sciences descriptors used were “Intensive Care Unit”, “Covid-19” and “Prone” (prone position), using the Boolean operator “AND”. The original publications were established as inclusion criteria, available in full in Portuguese, English and Spanish, published from 2020 to 2022. As it is a literature review, the study did not require approval from the ethics committee. They resulted in 14 scientific articles, eight from Capes and six from PubMed. Benefits were reported by seven articles, complications by two, and five dealt with the two themes (benefits and complications). Although this review did not make it possible to define the indications for the use of the prone position, some benefits pointed out were the improvement in the PaO2/FiO2 ratio, oxygenation, reduction in length of stay and mortality, and better lung compliance. With regard to complications, pressure injuries and accidental removal of medical devices such as an endotracheal tube and peripheral and central venous accesses occur. Finally, prone positioning was used in intubated and non-intubated patients, with significant PaO2/FiO2 improvements in prone patients during the Covid-19 pandemic. The limitation in this review is that there is heterogeneity in the studies regarding the pronation criteria, its definition, use, benefits and complications, with cohort methods, cross-sectional studies and with casuistic interventions. Although the pandemic has already ended, retrospective studies are suggested to better investigate the conduct of pronation in patients with Covid-19 in intensive care.
Medicina Intensiva, 2022
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
European Journal of Medical Research, 2024
Background Prone positioning (PP) is a low-cost method with minimal risk to the patient that improves the oxygenation of patients with acute hypoxic respiratory failure (AHRF) due to COVID-19 pneumonia, thereby reducing their need for tracheal intubation (TI) and transferring to the intensive care unit (ICU). We aimed to overview the results of all previous systematic reviews and meta-analyses to examine the net effect of PP on oxygenation, the rate of TI and mortality in COVID-19 patients. Methods We searched PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases from December 2019 through 2022 without publication language restriction for systematic reviews and meta-analysis studies on PP vs. supine position (SP) in conscious patients with hypoxic respiratory failure COVID-19. After study selection, data were extracted from published meta-analyses and pooled by comprehensive meta-analysis (CMA) software version 2.2.064 to achieve effect sizes. They were analyzed for TI and mortality rates dichotomous variables, and the results were shown as pooled odds ratios (OR) with a 95% confidence interval (CI). Continuous variables such as oxygenation indices (PaO2/FiO2 and SpO2) were also analyzed, and the data were shown as mean differences (MD) with lower and upper CI. The level of statistical significance was set at p ≤ 0.05. Results Twelve systematic reviews and meta-analyses with 19,651 patients and six systematic reviews with 2,911 patients were included in this Review of Reviews (total: 22,562). PP treatment significantly reduced the rate of TI (OR = 0.639, %95 CI (0.492, 0.829); P-value = 0.001) and decreased mortality (OR = 0.363, %95 CI (0.240, 0.549), P-value < 0.001). There was no difference in PaO2/FiO2 (MD = 3.591[− 40.881, 48.062]; P-value = 0.874) and SpO2 percent (MD = 1.641[− 4.441, 7.723]; P-value = 0.597). Conclusion Prone positioning can be recommended in conscious ICU patients with COVID-19 pneumonia to reduce mortality and intubation.
Impact of prone position on outcomes of COVID-19 patients with spontaneous breathing
Acute and Critical Care, 2021
Background: In this study, we explored whether early application of the prone position (PP) can improve severe hypoxemia and respiratory failure in coronavirus disease 2019 (COVID-19) patients with spontaneous breathing.Methods: This is a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. All vital parameters were recorded in real time for all patients. Moreover, the results of chest computed tomography (CT), when available, were analyzed.Results: PP was applied in 21 patients who were breathing spontaneously. The application of PP was associated with a significant increase in oxygen saturation measured by pulse oximetry (SpO2) from 82%±12% to 96%±3% (P<0.001) 1 hour later. Moreover, PP was associated with a significant reduction in respiratory rate from 31±10 to 21±4 breaths/min (P<0.001). Furthermore, the number of patients who exhibited signs of respiratory distress after PP was reduced from 10 (47%) to 3 (...