Is prolonged period of prone position effective and safe in mechanically ventilated patients with SARS-CoV-2? A randomized clinical trial

Hafez, Amr Fouad; Sayed, Rania Gamal El; Elrahman, Ahmed S. Abd; Kamal, Farouk

doi:10.1080/11101849.2022.2077048

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…Another observational study have shown sustained responses to prolonged (beyond 16 h) prone positioning in mechanically ventilated COVID-19 patients [ 32 ]. A randomized control trial of 52 mechanically ventilated COVID-19 patients with prolonged proning for 24 h showed that this was safe and demonstrated improved outcomes [ 33 ]. However, this study did not directly compare the beneficial effects of 16 h with 24 h. Observational studies also concur with this RCT, where an extended duration of prone positioning beyond 16 h may confer better clinical outcomes with a reduction in staff demands but at the expense of an increased risk of prone-related complications [ 34 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes

Jackson,

Neyroud,

Barnsley

et al. 2023

JCM

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The COVID-19 pandemic led to a broad implementation of proning to enhance oxygenation in both self-ventilating and mechanically ventilated critically ill patients with acute severe hypoxic respiratory failure. However, there is little data on the impact of the timing of the initiation of prone positioning in COVID-19 patients receiving mechanical ventilation. In this study, we analyzed our proning practices in mechanically ventilated COVID-19 patients. There were 931 total proning episodes in 144 patients, with a median duration of 16 h (IQR 15–17 h) per proning cycle. 563 proning cycles were initiated within 7 days of intubation (early), 235 within 7–14 days (intermediate), and 133 after 14 days (late). The mean change in oxygenation defined as the delta PaO2/FiO2 ratio (ΔPF) after the prone episode was 16.6 ± 34.4 mmHg (p < 0.001). For early, intermediate, and late cycles, mean ΔPF ratios were 18.5 ± 36.7 mmHg, 13.2 ± 30.4 mmHg, and 14.8 ± 30.5 mmHg, with no significant difference in response between early, intermediate, and late proning (p = 0.2), respectively. Our findings indicate a favorable oxygenation response to proning episodes at all time points, even after >14 days of intubation. However, the findings cannot be translated directly into a survival advantage, and more research is needed in this area.

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Section: Discussionmentioning

confidence: 99%

Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes

Jackson,

Neyroud,

Barnsley

et al. 2023

JCM

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“…Perpanjangan durasi prone posisi juga mengakibatkan peningkatan yang signifikan pada static compliance (Cstat). Nilai mean Cstat adalah 26.8 ± 5.6 pada kelompok kontrol dan 27.0 ± 6.3 pada kelompok prolonged PP (Hafez et al, 2022).…”

Section: Pembahasanunclassified

“…Penelitian lain terkait komplikasi luka tekan didapatkan kejadian edema wajah sangat umum terjadi (73.1%) pada kedua kelompok dengan tidak ada perbedaan yang signifikan, tidak ada kelemahan anggota badan, atau cedera saraf ditemui, juga 12 pasien (46.2%) dari kelompok prolonged prone mengalami luka tekanan ventral dan 10 pasien (38.5%) mengalami luka tekanan ventral pada kelompok kontrol. Perbedaannya tidak signifikan secara klinis karena dalam dekanulasi, hal ini relatif jarang terjadi ketika satu pasien dalam kelompok kontrol dan dua pasien pada kelompok prolonged prone (Hafez et al, 2022).…”

Section: Pembahasanunclassified

Effectiveness of prolonged prone positioning in acute respiratory distress syndrome using mechanical ports: A systematic review

Dewi,

Herawati

2024

J.HolHealth

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Background: Acute respiratory distress syndrome (ARDS) is a pulmonary condition that triggers a systemic inflammatory response with different etiologies that has distinctive pathological clinical characteristics. This study discusses the provision of prolonged prone position as supportive therapy to improve oxygenation status in ARDS patients as well as the complications that may arise from prolonged prone position. Purpose: To compile and collect the latest evidence on prolonged prone positioning therapy in ARDS patients. Method: Design a systematic review with PRISMA guidelines using databases from ScienceDirect, Proquest, PubMed, and Scopus. Search for articles with the keywords “prolonged prone position” AND “ARDS” AND “benefits” AND “complications”. Results: All nine articles recognized the positive influence of prolonged prone position on oxygenation status in ARDS patients, but had no effect on patient mortality rates. However, prolonged prone positioning has several complications related to nerve disorders in parts of the body that are under pressure for a long time, prolonged use of sedation medication which affects the prolonged use of mechanical ventilation, long ICU stay, and other complications. In terms of efficiency, prolonged prone positioning provides convenience for health workers because it does not require more time and energy in changing the patient's position repeatedly. Conclusion: Prolonged prone positioning has been proven to be effective and safe for patients. This position can be used and reduces the workload of health care workers, but complications related to this position require good monitoring regarding clinical and neurological parameters. Suggestion: Further research needs to be done regarding the appropriate duration of proneness so that it can provide an optimal positive impact and possibly minimize the risk of complications. Further research involving patient groups may provide a deeper understanding of the benefits and risks of prolonged prone positioning interventions. Keywords: Acute Respiratory Distress Syndrome (ARDS); Benefit; Complication; Prolonged Prone Position. Pendahuluan: Acute respiratory distress syndrome (ARDS) merupakan kondisi paru yang memicu respon inflamasi sistemik dengan etiologi yang berbeda yang memiliki ciri-ciri klinis patologis khas. Penelitian ini menganalisis tentang pemberian posisi prolonged prone position sebagai terapi suportif untuk meningkatkan status oksigenasi pada pasien ARDS serta komplikasi yang mungkin ditimbulkan dari pemberian prolonged prone position tersebut. Tujuan: Untuk menyusun dan mengevaluasi bukti-bukti terkini tentang terapi prolonged prone position pada pasien ARDS. Metode: Systematic review design dengan panduan PRISMA menggunakan database dari ScienceDirect, Proquest, PubMed, dan Scopus. Pencarian artikel dengan kata kunci “prolonged prone position” AND “ARDS” AND “benefit” AND “complication”. Hasil: Kesembilan artikel mengakui pengaruh positif prolonged prone position terhadap status oksigenisasi pada pasien dengan ARDS, namun tidak berpengaruh pada tingkat mortalitas pasien. Namun pemberian prolonged prone position memiliki beberapa komplikasi terkait dengan gangguan neurologis pada bagian tubuh yang mendapat penekanan dalam waktu yang lama, penggunaan obat sedasi yang lama yang berpengaruh pada penggunaan ventilasi mekanik yang lama, lama perawatan ICU, dan komplikasinya. Dari segi efisiensi, prolonged prone position memberikan kemudahan bagi tenaga kesehatan karena tidak memerlukan waktu dan tenaga lebih dalam perubahan posisi pasien yang berulang-ulang. Simpulan: Pemberian prolonged prone position (PPP) telah terbukti efektif dan aman untuk pasien. Posisi ini dapat dilakukan untuk mengurangi beban kerja petugas layanan kesehatan, namun komplikasi terkait pemberian posisi ini perlu dilakukan pemantauan yang baik terkait parameter klinis dan neurologisnya. Saran: Perlu dilakukan penelitian lebih lanjut terkait durasi prone yang tepat, sehingga dapat memberikan dampak positif secara optimal dan kemungkinan risiko komplikasi yang minimal. Penelitian lanjutan yang melibatkan kelompok pasien dapat memberikan pemahaman yang lebih mendalam terkait manfaat dan risiko dari intervensi prolonged prone position.

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“…Beberapa penelitian yang mengkaji secara khusus mengungkapkan bahwa peningkatan saturasi oksigen secara signifikan selama hari ke 1-3 (P<0,01) dan PaO 2 : FiO 2 meningkat signifikan hari ke 4-7 dengan nilai P<0,05 (Sryma et al, 2021). Kemudian penelitia Hafez et al, (2022) menyatakan terdapat peningkatan SPO 2 pada 10 menit pertama dari 91,09% menjadi 95,30% dan meningkat menjadi 95,48% pada 30 menit berikutnya. Hasil serupa ditemukan pada hasil penelitian Darban et al, (2022); Jayakumar et al, (2021); Qian et al, (2022) yang menyatakan ada pengaruh prone positioning terhadap oksigenasi pasien COVID-19.…”

Section: Pendahuluanunclassified

Prone Positioning terhadap Status Oksigenasi pada Pasien COVID-19

Rohwandi

Rumahorbo

Susilawati

et al. 2022

JKS

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This study systematically reviews the effectiveness of Prone Positioning on the oxygenation status of COVID-19 patients from the existing literature. The research method uses a systematic literature review and meta-analysis obtained from the google scholar database. Proquest, Pubmed, Science Direct, and Semantic Scholar. The results showed that based on oxygenation parameters, Prone Positioning had an effect on changes in the ROX index value (Mean Difference 3.89, 95% CI 0.08 to 7.70, P = 0.05), P/F Ratio (Mean Difference 17.88, 95% CI 5.44 to 30.33 , P=0.05), SPO2 (Mean Difference 1.98, 95% CI 1.29 to 2.68, P<0.00001), and S/F Ratio (Mean Difference 23.04, 95% CI 15.89 to 30.19, P <0.00001), while the respiratory rate parameters (Mean Difference -0.79, 95% CI -1.76 to -0.18, P=0.11) and PaO2 (Mean Difference 7.75, 95% CI -22.80 to -38.31, P= 0.62) did not show a significant difference. In conclusion, Prone Positioning is considered to significantly affect changes in the oxygenation of COVID-19 patients. It is expected to be a reference in implementing nursing interventions for oxygenation disorders in patients. Keywords: COVID-19, Oxygenation, Positioning, Prone

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Is prolonged period of prone position effective and safe in mechanically ventilated patients with SARS-CoV-2? A randomized clinical trial

Cited by 4 publications

References 18 publications

Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes

Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes

Effectiveness of prolonged prone positioning in acute respiratory distress syndrome using mechanical ports: A systematic review

Prone Positioning terhadap Status Oksigenasi pada Pasien COVID-19

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