Beneficial effect of awake prone position in hypoxaemic patients with <scp>COVID</scp>‐19: case reports and literature review

Cohen, Dor; Wasserstrum, Yishay; Segev, Amitai; Avaky, Chen; Negru, Liat; Turpashvili, Natia; Anani, Sapir; Zilber, Eyal; Lasman, Nir; Athamna, Ahlam; Segal, Omer; Shenhav‐Saltzman, Gilat; Segal, Gad

doi:10.1111/imj.14926

Cited by 20 publications

(18 citation statements)

References 10 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This case report illustrates two important findings: after survival from a severe life-threatening COVID-19 infection complicated by ARDS and multiple organ failure, our patient became sustained hypertensive throughout the convalescent period; prone positioning contributed to significant improvement of his arterial oxygenation, and the need for supplemental oxygen was substantially reduced due to less mismatch between ventilation and circulation [ 7 - 8 ].…”

Section: Discussionmentioning

confidence: 94%

Characteristics of 24-hour Ambulatory Blood Pressure Monitoring in a COVID-19 Survivor

et al. 2021

View full text Add to dashboard Cite

COVID-19 infection primarily causes severe pneumonia complicated by acute respiratory distress syndrome and multiorgan failure requiring a ventilator support. We present a case of a 55-year-old male, admitted with COVID-19. He was obese but had no other medical conditions. His blood pressure was measured by his general physician on several occasions in the past, all values being normal (<140/90 mmHg). He developed multiorgan failure, requiring vasopressor and ventilator support for 17 days. A prone positioning improved the arterial oxygenation, and reduced the need for supplemental oxygen. After recovery, he showed persistently elevated blood pressure and sinus tachycardia both in clinic and out-of-clinic. The activation of the renin–angiotensin–aldosterone and sympathetic systems, volume-overload, hyperreninemia and cytokine storm might have contributed to the exaggerated cardiovascular response.

show abstract

Section: Discussionmentioning

confidence: 94%

Characteristics of 24-hour Ambulatory Blood Pressure Monitoring in a COVID-19 Survivor

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Revisão de literatura usando bases de dados, buscador genérico de internet e financiadores de saúde. Cohen, D. et al, 2020 Beneficial effect of awake prone position in hypoxaemic patients with COVID-19: case reports and literature review Revisar o conceito de posição de prona acordada após apresentar dois relatos de caso de pacientes com COVID-19 moderada.…”

Section: Resultsunclassified

Benefícios da posição de prona em pacientes com COVID-19 não-intubados

Bigaran

Meira²,

Silva³

et al. 2021

RSD

View full text Add to dashboard Cite

O objetivo do estudo foi evidenciar os benefícios da posição de prona em pacientes com COVID-19 não-intubados. Trata-se de uma revisão integrativa da literatura, usando os descritores “prone position” and “coronavirus” not “respiration, artificial”, usando as bases de dados PubMed, o Google Scholar, a Biblioteca Virtual em Saúde (BVS), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Após aplicação dos critérios de inclusão e exclusão, utilizou-se o fluxograma PRISMA para elucidar a seleção dos artigos e uma tabela mostrando os resultados que compõem a revisão. A posição de prona em pacientes acometidos pelo SARS-COV-2 em ventilação não-invasiva trouxe principalmente uma redução do esforço respiratório e com isso foi relatado que a mesma levou a uma menor incidência de intubação. Ainda, a mesma pode melhorar a homogeneidade pulmonar, a redistribuição pulmonar, a complascência pulmonar, a proporção de recrutamento para infiltração e o recrutamento de pulmão. Conclui-se, que a posição de prona proporciona diversos benefícios para os pacientes não-intubados com COVID-19, proporcionando melhora da saturação e redução da mortalidade, além de prevenir a intubação.

show abstract

“…Prone positioning in mechanically ventilated patients with COVID-19 improves oxygenation and is associated with reduced mortality [33]. Although APP similarly improves oxygenation in non-intubated patients with COVID-19 [3,[16][17][18][19][20][21][22][23], reports have failed to show bene ts on patient-centered outcomes [25,26]. A multicenter observational study, investigating a cohort of 199 patients with COVID-19 found no difference in intubation rates in patients with duration of APP for more than 16 hours per day compared with shorter duration of APP [25].…”

Section: Discussionmentioning

confidence: 99%

“…It increases lung volume [10,11], improves ventilation-perfusion ratio [12][13][14], and distributes pleural pressure more evenly [15]. Several studies report transient improvement in oxygenation during APP in a majority of patients with hypoxemic respiratory failure due to COVID-19 pneumonia [3,[16][17][18][19][20][21][22][23]. However, translating physiological improvement into clinically relevant outcomes has not been supported by ARDS-studies [24] and there remains a gap in the current knowledge for the use of APP [25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Awake Prone Positioning in Patients with Hypoxemic Respiratory Failure Due to COVID-19: The PROFLO Multicenter Randomized Clinical Trial

Rosén

Oelreich

Fors

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: The effect of awake prone positioning on intubation rates is not established. The aim of this trial was to investigate if a protocol for awake prone positioning reduces the rate of endotracheal intubation compared with standard care among patients with moderate to severe hypoxemic respiratory failure due to COVID-19. Methods: We conducted a multicenter randomized controlled trial. Adult patients with confirmed COVID-19, high-flow nasal oxygen or noninvasive ventilation for respiratory support and a PaO2/FiO2 ratio ≤ 20 kPa were randomly assigned to a protocol targeting 16 hours prone positioning per day or standard care. The primary endpoint was intubation within 30 days. Secondary endpoints included duration of awake prone positioning, 30-day mortality, ventilator free days, hospital and intensive care unit length of stay, use of noninvasive ventilation, organ support and adverse events. The trial was terminated early due to futility. Results: Of 141 patients assessed for eligibility, 75 were randomized of whom 39 were allocated to the control group and 36 to the prone group. Within 30 days after enrollment, 13 patients (33%) were intubated in the control group versus 12 patients (33%) in the prone group (HR 1.01 (95% CI 0.46-2.21), P=0.99). Median prone duration was 3.4 hours [IQR 1.8-8.4] in the control group compared with 9.0 hours per day [IQR 4.4-10.6] in the prone group (P=0.014). Nine patients (23%) in the control group had pressure sores compared with two patients (6%) in the prone group (difference -18% (95% CI -2% to -33%); P=0.032). There were no other differences in secondary outcomes between groups.Conclusions: A protocol for awake prone positioning increased duration of prone positioning, but did not reduce the rate of intubation in patients with hypoxemic respiratory failure due to COVID-19 compared to standard care.Trial registration: ISRCTN54918435. Registered 15 June 2020 (https://doi.org/10.1186/ISRCTN54917435)

show abstract

Beneficial effect of awake prone position in hypoxaemic patients with COVID‐19: case reports and literature review

Cited by 20 publications

References 10 publications

Characteristics of 24-hour Ambulatory Blood Pressure Monitoring in a COVID-19 Survivor

Characteristics of 24-hour Ambulatory Blood Pressure Monitoring in a COVID-19 Survivor

Benefícios da posição de prona em pacientes com COVID-19 não-intubados

Awake Prone Positioning in Patients with Hypoxemic Respiratory Failure Due to COVID-19: The PROFLO Multicenter Randomized Clinical Trial

Contact Info

Product

Resources

About