Early awake proning in critical and severe COVID-19 patients undergoing noninvasive respiratory support: A retrospective multicenter cohort study

Tonelli, Roberto; Pisani, Lara; Tabbì, Luca; Comellini, Vittoria; Prediletto, Irene; Fantini, Riccardo; Marchioni, Alessandro; Andrisani, Dario; Gozzi, Filippo; Bruzzi, Giulia; Manicardi, Linda; Busani, Stefano; Mussini, Cristina; Castaniere, Ivana; Bassi, Ilaria; Carpano, Marco; Tagariello, Federico; Corsi, Gabriele; D’Amico, Roberto; Girardis, Massimo; Nava, Stefano; Clini, Enrico

doi:10.1016/j.pulmoe.2021.03.002

Cited by 41 publications

(65 citation statements)

References 33 publications

(27 reference statements)

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“…The value of APP 39 alongside non-invasive ventilation 40 in reducing intubation is questionable, and our results uphold this. Some observational studies have reported decreased respiratory rate and excessive work of breathing amongst those awake proned resulting in a trend toward reduced intubation rate 9 , 14 , 17 , 18 . On the contrary, a prospective observational study found no benefit in reducing the risk of intubation but rather showed a trend for delay 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Several observational studies support the use of APP to improve oxygenation for spontaneously breathing patients affected by respiratory failure 13 , 14 , 15 , 16 , 17 , 18 . Its effectiveness in reducing intubation rate and mortality remains unclear 19 , 20 , 21 , 22 , 23 as well as its tolerability 24 , 25 , timing and optimal duration 26 .…”

Section: Introductionmentioning

confidence: 96%

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Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis

Fazzini

Page

Pearse

et al. 2022

British Journal of Anaesthesia

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis

Fazzini

Page

Pearse

et al. 2022

British Journal of Anaesthesia

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“…Four RCTs 6,20,22,23 were of moderate quality, and one RCT 17 was of high quality. Six observational studies 5,13,15,16,19,21 had a total score >6, indicating that they were of high quality. Three observational studies 14,18,24 scored 6, indicating that they were of moderate quality.…”

Section: Quality and Publication Bias Assessmentmentioning

confidence: 99%

Effect of Prone Positioning on Clinical Outcomes of Non-Intubated Subjects With COVID-19

et al. 2021

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“…Awake self-proning has been described in small observational, mostly retrospective cohorts in non-COVID-19 [ 115 , 116 ] and COVID-19 [ 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 ] patients with acute hypoxemia. Turning the awake hypoxemic patient prone was feasible, safe [ 117 , 120 , 125 , 126 , 130 ] and in most cases improved oxygenation [ 117 , 119 , 120 , 125 , 126 , 128 , 129 ], with a mean PaO 2 /FiO 2 difference of 51.3 mmHg (95% CI 13.91–88.67) [ 131 ].…”

Section: Prone Position During High-flow Nasal Oxygen or Noninvasive Ventilation In Patients With Covid-19mentioning

confidence: 99%

The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia

Akoumianaki

Ischaki

Karagiannis

et al. 2021

JPM

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Acute hypoxemic respiratory failure is the principal cause of hospitalization, invasive mechanical ventilation and death in severe COVID-19 infection. Nearly half of intubated patients with COVID-19 eventually die. High-Flow Nasal Oxygen (HFNO) and Noninvasive Ventilation (NIV) constitute valuable tools to avert endotracheal intubation in patients with severe COVID-19 pneumonia who do not respond to conventional oxygen treatment. Sparing Intensive Care Unit beds and reducing intubation-related complications may save lives in the pandemic era. The main drawback of HFNO and/or NIV is intubation delay. Cautious selection of patients with severe hypoxemia due to COVID-19 disease, close monitoring and appropriate employment and titration of HFNO and/or NIV can increase the rate of success and eliminate the risk of intubation delay. At the same time, all precautions to protect the healthcare personnel from viral transmission should be taken. In this review, we summarize the evidence supporting the application of HFNO and NIV in severe COVID-19 hypoxemic respiratory failure, analyse the risks associated with their use and provide a path for their proper implementation.

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Early awake proning in critical and severe COVID-19 patients undergoing noninvasive respiratory support: A retrospective multicenter cohort study

Cited by 41 publications

References 33 publications

Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis

Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis

Effect of Prone Positioning on Clinical Outcomes of Non-Intubated Subjects With COVID-19

The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia

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