Effect of proning in patients with COVID-19 acute hypoxemic respiratory failure receiving noninvasive oxygen therapy

Pb, Sryma; Mittal, Saurabh; Madan, Karan; Tiwari, Pawan; Bhatnagar, Sushma; Trikha, Anjan; Dosi, Ravi; Bhopale, Shweta; Viswanath, Renjith; Hadda, Vijay; Guleria, Randeep; Baldwa, Bhvya

doi:10.4103/lungindia.lungindia_794_20

Cited by 19 publications

(19 citation statements)

References 16 publications

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“…A study carried out in England by Winearls et al 29 reported that the use of PP with CPAP significantly improved the ROX index in patients with COVID‐19. Similarly, Sryma et al 30 found significant improvement in the ROX index values in the study group compared with that in the control group 30 min after PP initiation.…”

Section: Discussionmentioning

confidence: 62%

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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Section: Discussionmentioning

confidence: 62%

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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“… 30 In addition, only a few studies have utilized control group for the evaluation of awake PP. 13 , 18 , 19 In all these studies, the assessment for improved oxygenation was undertaken as early as 1 hour 13 , 18 till the end of day one. 19 These studies’ results highlighting the improvement in oxygenation following such a short duration of awake PP could possibly be implicated to the transient lung recruitment.…”

Section: Discussionmentioning

confidence: 99%

Awake Prone Positioning in the Management of COVID-19 Pneumonia: A Systematic Review

Chilkoti¹,

Mohta²,

Saxena³

et al. 2021

Indian Journal of Critical Care Medicine

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Background: The aim was to investigate the efficacy of prone positioning (PP) in the management of coronavirus disease-2019 (COVID-19) pneumonia in various setups, with various modes of oxygen therapy and its optimal duration. Materials and methods: A systematic literature search was conducted from inception until May 15, 2021. Patients with a validated diagnosis of COVID-19 and receiving PP were included. Various factors, including intensive care unit (ICU) or non-ICU setup, mode of oxygen therapy, outcome, duration of proning, and limitations, were noted. Results: We retrieved 36 articles with a total of 1,385 patients for qualitative analysis. Out of 36 articles, there were 17 original articles, 09 case series, and 10 case reports. Out of 1,385 participants, 78.9% ( n = 1,093) and 21.0% ( n = 292) of patients were managed in ICU and non-ICU setup, respectively. Awake PP with high flow nasal cannula (HFNC) was found to be a promising technique; however, the result was inconclusive with helmet continuous positive airway pressure (CPAP). No study has evaluated the optimal duration of awake PP and the associated long-term outcomes. Conclusion: We encourage the use of early awake self-proning in the management of COVID19 disease. However, the evidence in terms of its use in non-ICU setup, the optimal duration of PP, and various oxygenation devices are insufficient, thereby mandating further well-designed multicentric studies to evaluate its efficacy as an adjunct in the management of COVID-19 pneumonia in context to the aforementioned factor. How to cite this article: Chilkoti GT, Mohta M, Saxena AK, Ahmad Z, Sharma CS. Awake Prone Positioning in the Management of COVID-19 Pneumonia: A Systematic Review. Indian J Crit Care Med 2021;25(8):896–905.

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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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Effect of proning in patients with COVID-19 acute hypoxemic respiratory failure receiving noninvasive oxygen therapy

Cited by 19 publications

References 16 publications

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

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

Awake Prone Positioning in the Management of COVID-19 Pneumonia: A Systematic Review

Prone position in COVID 19-associated acute respiratory failure

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