Long-term complications of prone position ventilation with relevance for acute and postacute rehabilitation: a systematic review of the literature

Abstract

INTRODUCTION Prone positioning ventilation (PPV) is an effective treatment for patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite the benefits of PPV, different kinds of short and long-term consequences have been noted. This review summarizes long-term complications of PPV that impact treatment strategies and outcomes in acute and postacute rehabilitation. EVIDENCE ACQUISITION PubMed/Medline, Cochrane Library, Cochrane COVID-19 Study Register databases and the Google Scholar search engine were systematically searched for studies investigating long-term complications of PPV. The final search date for all sources/databases was January 31, 2022. For our methodological appraisal, we conducted a systematic review of articles without any restrictions on types of articles or publication dates. Only articles published in English and available as full texts were eligible for inclusion. After the screening process, data of interest were extracted from eligible sources: PPV sequelae and conclusions ( i.e. possible effects on the course of rehabilitation and therapy strategies). EVIDENCE SYNTHESIS A total of 59 studies are included in this review. Long-term consequences are mainly pressure ulcers and nerve lesions that exist after discharge from the Intensive Care Unit (ICU). Publications rarely recommend treatment strategies for long-term complications after PPV. Due to the quality of the included studies, no robust conclusions as to effective strategies can be drawn. CONCLUSIONS Further high-quality research is required, considering the different long-term complications after PPV and their impact on rehabilitation in order to draw conclusions about viable physical therapies. Crucially, however, prone positioning (PP) sequelae pose new challenges to physicians and therapists in acute and postacute rehabilitation medicine as well as follow-up care.

Extended prone positioning for intubated ARDS: a review

“…This question requires further inquiries. Other long-term complications include peripheral nerve injuries, in particular peroneal nerve palsy and injury of the lateral femoris cutaneous nerve and ocular complications [ 35 ]. A summary of the potential benefits and complications of extended PP is shown in Fig.…”

“…Respiratory therapists might help reduce acute complications such as endotracheal tube removal [ 38 ], and dieticians are key actors to optimize enteral feeding tolerance [ 39 ]. Rehabilitation physicians and physiotherapists also play an important role in managing long-term complications after ICU discharge [ 35 ].…”