Effects of prone and lateral positioning alternate in high-flow nasal cannula patients with severe COVID-19

Nan, Chuanchuan; Mu, Wenjing; Wang, Changsong; Zhao, Mingyan; Yu, Kaijiang

doi:10.1186/s13054-022-03897-2

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…The novelty of our study is the finding that the COVID-19 patients presenting with acute respiratory failure and undergoing the lateral approach for hip fracture, showed a better level of oxygenation when compared to the patients treated with the direct anterior approach (the pre-operative and day one post-operative P/F in the group A were 273.16 vs. 279.69, while the P/F in the group B were 301.56 vs. 226.72, p < 0.05, respectively, Table 7 ), despite the fact that the mortality of the COVID-19 patients remains high, due to the different immune-response and other independent factors related to the infection per se. These results are in line with the previous findings on improving oxygenation in lateral and prone positions [ 22 , 57 , 58 , 59 , 60 , 61 , 62 ]. Indeed, the previous data on COVID-19 patients showed that the acute respiratory failure COVID-19 patients responded well to proning and/or alternative body position [ 57 , 58 , 59 , 60 , 61 , 62 ], for several reasons arising from: (1) the redistribution of the ventilation to perfusion mismatch, due to the gravity-induced increase of the blood flow to the spared regions of the lung, which thus become better ventilated; and (2) the improved P/F ratio, due to the lung recruitment of previously dependent lung regions, that ameliorates the hypoxemic vasoconstriction, reducing the pulmonary vascular resistance and improving the right ventricular function.…”

Section: Discussionsupporting

confidence: 93%

“…These results are in line with the previous findings on improving oxygenation in lateral and prone positions [ 22 , 57 , 58 , 59 , 60 , 61 , 62 ]. Indeed, the previous data on COVID-19 patients showed that the acute respiratory failure COVID-19 patients responded well to proning and/or alternative body position [ 57 , 58 , 59 , 60 , 61 , 62 ], for several reasons arising from: (1) the redistribution of the ventilation to perfusion mismatch, due to the gravity-induced increase of the blood flow to the spared regions of the lung, which thus become better ventilated; and (2) the improved P/F ratio, due to the lung recruitment of previously dependent lung regions, that ameliorates the hypoxemic vasoconstriction, reducing the pulmonary vascular resistance and improving the right ventricular function. The need for surgery should exactly match the need for ventilator management of those patients, in order to avoid an increased risk of worsening the clinical condition after surgery and the need for high observation or a bed in ICU, given the lack of resources during the pandemic.…”

Section: Discussionsupporting

confidence: 93%

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Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease

Maccagnano

Maruccia

Rauseo

et al. 2022

JCM

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Background: During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA), comparing direct lateral (DL) versus direct anterior approach (DAA). Methods: A single-center, observational retrospective study including 50 patients affected by COVID-19 infection (30 males, 20 females) who underwent HA between April 2020 to April 2021 was performed. The patients were allocated into two groups according to the surgical approach used: lateral approach and anterior approach. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO2), fraction of the inspired oxygen (FiO2), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO2/FiO2), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. The patients were stratified into five groups according to Alhazzani scores. A non-COVID-19 group of patients, as the control, was finally introduced. Results: A lateral position led to a better level of oxygenation (p < 0.01), compared to the supine anterior approach. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients lying in the lateral position. A statistically significant reduction in the surgical time emerged in patients treated with DAA (p < 0.01). Patients within the DAA group had a significantly lower blood loss compared to direct lateral approach. Conclusions: DL approach with lateral decubitus seems to preserved respiratory function in HA surgery. Thus, the lateral position may be associated with beneficial effects on gas exchange.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease

Maccagnano

Maruccia

Rauseo

et al. 2022

JCM

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“…While early in the pandemic there was a practice of early intubation, as the pandemic evolved multiple non-invasive forms of pulmonary support was increasing used, including high flow nasal cannula and prone positioning in attempts to avoid intubation. 100,101 This topic of avoiding harmful therapies is critical as there are certain therapies that have never been shown to provide benefit in COVID-19 and are only associated with wasted opportunity costs or harm and many therapies that provide benefit during the Early Viral Upper Respiratory Nonhypoxic Phase but provide only minimal benefit, no benefit or can cause harm if given during the Early Inflammatory Lower Respiratory Hypoxic Phase. Remdesivir is an example of a therapeutic agent with great efficacy when given early but with mixed results when given after the period of viral replication and the onset of the Early Inflammatory Lower Respiratory Hypoxic Phase.…”

Section: Early Inflammatory Lower Respiratory Hypoxic Phasementioning

confidence: 99%

COVID-19: Using the Right Tools at the Right Time

Griffin

2022

MRAJ

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COVID-19, caused by SARS-CoV2, first described in several cases of pneumonia in Wuhan, China in December 2020 has now become a disease that is now present throughout the world. Multiple evidence-based measures and therapeutics are now available for the prevention and treatment of COVID-19. Many therapeutics have been studied and some even continue to be used without compelling evidence to suggest efficacy. Critical to the prevention and successful identification of treatments for COVID-19 has been an appreciation of the multiple stages of this disease. A previous paper published in February 2021 presented a consensus framework of relevant stages of COVID-19 authored by 35 physicians and scientist from multiple disciplines and countries. This framework included: three periods: the period of pre-exposure, the incubation period, the period of detectable viral replication, and five phases: the viral symptom phase, the early inflammatory phase, the secondary infection phase, the multisystem inflammatory phase, and the tail phase. This common terminology has served as a framework to guide COVID-19 therapeutics studied or currently in use. We now have a greater understanding of this disease and an update framework with two preclinical periods, the Pre-exposure Period and the Incubation Period, followed by four clinical phases, the Early Viral Upper Respiratory Non-hypoxic Phase, the Early Inflammatory Lower Respiratory Hypoxic Phase, the Secondary Symptomatic Phase and the Late Phase. We also have more evidence regarding the role of improved ventilation, the effectiveness of different masks, several highly effective vaccines, and a few effective antiviral, immunomodulatory, and supportive therapies. As there has been substantial progress made in understanding this disease and the role of various interventions, both nonpharmacological and pharmacological and changes over time in characteristics of SARS-CoV-2 such as a shorter incubation period and different susceptibility to various therapeutics, it is appropriate to put forth this update.

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“…First, we need to discuss the effect of HFNC according to changes in posture during ERCP procedure, such as lateral or prone positioning. Awake prone positioning in patients with acute hypoxemic respiratory failure due to COVID-19 treated with HFNC improved oxygen profiles and had preventable effect on the tracheal intubation or treatment failure [ 7 , 8 ]. Prone position may reduce ventilation to perfusion mismatch and intrapulmonary shunt and decrease respiratory rate.…”

Section: Replymentioning

confidence: 99%

Methodological Insight to the High-Flow Nasal Cannula Oxygenation in Elderly Undergoing Endoscopic Retrograde Cholangiopancreatography

2022

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Effects of prone and lateral positioning alternate in high-flow nasal cannula patients with severe COVID-19

Cited by 7 publications

References 5 publications

Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease

Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease

COVID-19: Using the Right Tools at the Right Time

Methodological Insight to the High-Flow Nasal Cannula Oxygenation in Elderly Undergoing Endoscopic Retrograde Cholangiopancreatography

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