Early prone positioning therapy for patients with mild COVID-19 disease

Liu, Xiaoyi; Liu, Hui; Lan, Qing; Zheng, Xiangde; Duan, Jun; Zeng, Fanwei

doi:10.1016/j.medcli.2020.11.036

Cited by 13 publications

(20 citation statements)

References 6 publications

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“…There were no changes in respiratory rate, heart rate, blood pressure (systolic and diastolic) before and after prone position. This is basically consistent with the research results of other scholars [41,43].…”

Section: Discussionsupporting

confidence: 93%

“…Some studies have found that for severe patients, prone position combined with mask oxygen or HFNC or non-invasive positive pressure ventilation can reduce the probability of endotracheal intubation and ultimately reduce patient mortality [38][39][40][41][42]. Other studies have shown that prone position may be more effective when performed early than later [10,43]. It has also been shown that the earlier patients are admitted to hospital for intervention, the less likely mild and moderate cases will progress to severe and critical [44].…”

Section: Discussionmentioning

confidence: 99%

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Prone position reduces the risk of patients with mild or moderate COVID-19 progressing to severe or even critical cases: a retrospective study

Wang

et al. 2022

Eur J Med Res

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Background To investigate whether prone position can reduce the risk of patients with mild or moderate COVID-19 who progress to severe or critical illness. Methods The prone position group was treated in prone position on the day of admission in addition to conventional treatment. Indicators such as saturation of pulse oximetry (SpO2), heart rate, blood pressure, respiratory rate, and prone position-related adverse events were recorded before prone ventilation, 5 min after prone position and 30 min after prone position. Meanwhile, the cases of severe and critical patients, the percentage of transformation and the final clinical outcome of this group were analyzed. Conversion rates and mortality were calculated for patients with mild or moderate COVID-19 retrieved from the database who received only conventional care without combined prone positioning as control group. Results (1) A total of 34 patients were included in prone position group. There were significant differences in SpO2 between the first 4 days after admission and the day of discharge (F = 3.17, P < 0.001). (2) The main complications were back and neck muscle soreness (55.9%), followed by abdominal distension (8.9%). (3) In control group, a total of 4873 cases of mild and moderate patients were included from 19 literatures, with an average deterioration rate of 22.7% and mortality rate of 1.7%. (4) In prone position group, there were no severe or critical transformation cases and also no death cases. The prone position group had a significantly lower deterioration rate when compared with the control group (χ2 = 9.962, P < 0.01). Conclusion Prone position improves SpO2 in patients with mild or moderate COVID-19. It can also reduce the percentage of mild or moderate patients progressing to severe or critical patients. The application of prone position is a simple, feasible, safe and effective treatment method in such patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Prone position reduces the risk of patients with mild or moderate COVID-19 progressing to severe or even critical cases: a retrospective study

Wang

et al. 2022

Eur J Med Res

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“… 33 Furthermore, the findings of this study showed no significant differences in the mean values of pH among the groups under study; however, we found a significant improvement in gas exchange parameters among patients receiving PP, as assessed by better before and after PaO 2 and SaO 2 values. The findings of this study agree with those of Liu et al, 34 who found that PP did not significantly affect the mean values of pH and PaCO 2 among the groups under study. In contrast, Jouffroy et al 35 have reported that the mean values of pH and PaCO 2 significantly improved after PP implementation, whereas the mean values of PaO 2 and SaO 2 showed no significant improvement with PP.…”

Section: Discussionsupporting

confidence: 93%

Effects of awake‐prone positioning on oxygenation and physiological outcomes in non‐intubated patients with COVID‐19: A randomized controlled trial

Othman

Elmenshawy

Mohamed

2022

Nursing in Critical Care

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Background Prone positioning is a well‐known supportive approach for increasing oxygenation and reducing mortality in non‐COVID‐19 patients with moderate to severe acute respiratory distress syndrome. However, studies highlighting the effects of proning in patients with COVID‐19 are limited. Aim To investigate the effects of awake‐prone positioning (APP) on oxygenation and physiological outcomes in non‐intubated patients with COVID‐19. Study Design A randomized controlled trial was carried out with two parallel groups at 1:1 ratio. Adult awake non‐intubated patients with confirmed COVID‐19, non‐rebreathing face mask or continuous positive airway pressure, PaO 2 /FiO 2 ratio ≤150 mmHg were randomly assigned to the APP group or control group. The control group was subjected to conventional positioning interventions. Outcome measures were PaO 2 /FiO 2 ratio, ROX index, PaO 2 , PaCO 2 , SaO 2 , respiratory rate, blood pressure, and shock index. These parameters were recorded immediately before positioning, 10 min after patient positioning, and 1 h after patient positioning. Results Of 115 patients assessed for eligibility, 82 were randomized to the APP group or control group (41 patients in each group). The use of APP for non‐intubated patients with COVID‐19 resulted in statistically significant improvements in oxygenation parameters, that is, SpO 2 , PaO 2 /FiO 2 , ROX index, PaO 2 , and SaO 2 , at the three study time points ( p = .000, .007, .000, .011, and .000 respectively). The SpO 2 was increased to 92.15 ± 2.735 mmHg for the APP group versus 88.17 ± 4.847 for the control group after 1 h of patients' positioning. The PaO 2 /FiO 2 ratio increased in the APP group before proning compared with 1 h after proning (79.95 ± 22.508 vs. 98.91 ± 34.44) respectively. APP improved the SpO 2 , PaO 2 /FiO 2 , ROX index, PaO 2 , and SaO 2 values for the APP group, representing an increase of 5.85%, 23.71%, 30.79%, 22.59%, and 5.26%, respectively. Conclusion Awake proning in non‐intubated patients with COVID‐19 showed marked improvement in oxygenation and physiological parameters. Relevance to Clinical Practice This study provides evidence for critical care nurses to implement APP in non‐intubated patients with COVID‐19 to improve oxygenation and physiological parameters, as it w...

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“…Seventeen studies (12 observational, 9 retrospective [15][16][17][18][19][20][21][22][23] and 3 prospective [24][25][26], and 5 RCTs [27][28][29][30][31]) met our inclusion criteria (Table 1). Six studies were done in the ICU and 11 outside the ICU (Table 1).…”

Section: Prone Position In Nonintubated Patientsmentioning

confidence: 99%

Prone position in COVID 19-associated acute respiratory failure

Kharat

Simon

Guérin

2021

Current Opinion in Critical Care

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Purpose of review Prone position has been widely used in the COVID-19 pandemic, with an extension of its use in patients with spontaneous breathing (’awake prone’). We herein propose a review of the current literature on prone position in mechanical ventilation and while spontaneous breathing in patients with COVID-19 pneumonia or COVID-19 ARDS. Recent findings A literature search retrieved 70 studies separating whether patient was intubated (24 studies) or nonintubated (46 studies). The outcomes analyzed were intubation rate, mortality and respiratory response to prone. In nonintubated patient receiving prone position, the main finding was mortality reduction in ICU and outside ICU setting. Summary The final results of the several randomized control trials completed or ongoing are needed to confirm the trend of these results. In intubated patients, observational studies showed that responders to prone in terms of oxygenation had a better survival than nonresponders.

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Early prone positioning therapy for patients with mild COVID-19 disease

Cited by 13 publications

References 6 publications

Prone position reduces the risk of patients with mild or moderate COVID-19 progressing to severe or even critical cases: a retrospective study

Prone position reduces the risk of patients with mild or moderate COVID-19 progressing to severe or even critical cases: a retrospective study

Effects of awake‐prone positioning on oxygenation and physiological outcomes in non‐intubated patients with COVID‐19: A randomized controlled trial

Prone position in COVID 19-associated acute respiratory failure

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