Lung ultrasound response to awake prone positioning predicts the need for intubation in patients with COVID-19 induced acute hypoxemic respiratory failure: an observational study

Ibarra‐Estrada, Miguel; Gamero-Rodríguez, María J.; García-de-Acilu, Marina; Roca, Oriol; Sandoval-Plascencia, Laura; Aguirre-Ávalos, Guadalupe; García-Salcido, Roxana; Aguirre-Díaz, Sara A.; Vines, David; Mirza, Sara; Kaur, Ramandeep; Weiss, Tyler T.; Guérin, Claude; Li, Jie

doi:10.1186/s13054-022-04064-3

Cited by 15 publications

(20 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other studies have investigated the aeration response to aPP in patients with acute respiratory failure related to COVID-19 using ultrasound scores [ 26 – 29 ]. Consistent results were observed with an improvement in aeration of the dorsal regions of the lungs during and after aPP, particularly in patients who benefited from the combination of aPP and high-flow O 2 nasal cannula [ 26 , 28 ] or non-invasive ventilation [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Awake prone position in COVID-19 acute respiratory failure: a randomised crossover study using electrical impedance tomography

et al. 2023

View full text Add to dashboard Cite

BackgroundThe goal of this study was to determine whether an awake prone position (aPP) reduces the global inhomogeneity (GI) index of ventilation measured by electrical impedance tomography (EIT) in COVID-19 patients with acute respiratory failure (ARF).MethodsThis prospective crossover study included COVID-19 patients with COVID-19 and ARF defined by PaO2:FiO2of 100–300 mmHg. After baseline evaluation and 30 min EIT recording in the supine position (SP), patients were randomized into one of two sequences: SP-aPP or aPP-SP. At the end of each 2 h step, oxygenation, respiratory rate, Borg scale, and 30 min EIT were recorded.ResultsTen patients were randomized in each group. The GI index did not change in the SP-aPP group (baseline 74±20%, end of SP 78±23% and end of aPP 72±20%, p=0.85) or in the aPP-SP group (baseline 59±14%, end of aPP 59±15% and end of SP 54±13%, p=0.67). In the whole cohort, PaO2:FiO2increased from 133±44 mmHg at baseline to 183±66 mmHg in aPP (p=0.003) and decreased to 129±49 mmHg in SP (p=0.03).ConclusionIn spontaneously breathing non-intubated COVID-19 patients with acute respiratory failure, aPP was not associated with a decrease of lung ventilation inhomogeneity assessed by EIT, despite an improvement in oxygenation.

show abstract

Section: Discussionmentioning

confidence: 99%

Awake prone position in COVID-19 acute respiratory failure: a randomised crossover study using electrical impedance tomography

et al. 2023

View full text Add to dashboard Cite

show abstract

“…They found that lung ultrasound assessment was more sensitive than the changes in oxygenation and respiratory rates. The reduction of LUS in the dorsal areas ≥1 point after the first APP session was associated with a decreased risk for intubation in patients undergoing APP (relative risk 0.25 [0.09–0.69]) [34 ▪ ]. Additionally, both Ibarra-Estrada et al .…”

Section: How To Assess Patient Response To Awake Prone Positioning?mentioning

confidence: 89%

“…Additionally, both Ibarra-Estrada et al . [34 ▪ ] and Musso et al . [36 ▪ ] found that longer APP duration was correlated with a higher reduction in LUS.…”

Section: How To Assess Patient Response To Awake Prone Positioning?mentioning

confidence: 91%

“…However, three to five days might be too long to evaluate patient response. In a follow-up study, Ibarra-Estrada et al [34 ▪ ] performed lung ultrasound assessments before, during, and after APP in the first three days among 71 COVID-19 patients. They found that lung ultrasound assessment was more sensitive than the changes in oxygenation and respiratory rates.…”

Section: How To Assess Patient Response To Awake Prone Positioning?mentioning

confidence: 99%

See 1 more Smart Citation

Prone positioning of nonintubated patients with acute hypoxemic respiratory failure

Roca

Ehrmann

2022

Current Opinion in Critical Care

Self Cite

View full text Add to dashboard Cite

Purpose of review Since the early pandemic, prone positioning has been broadly utilized for nonintubated patients (so-called ‘awake prone positioning, APP’) with coronavirus disease 2019 (COVID-19) induced acute hypoxemic respiratory failure (AHRF). Recent findings Numerous clinical studies have been conducted to investigate the effects of APP on oxygenation, intubation, and mortality. However, several questions remain unclear, such as the patient populations who benefit most from APP, the best length of daily duration on APP, how to improve adherence to APP, and the mechanisms of APP efficacy. Summary APP has been shown to improve oxygenation for patients with COVID-19 induced AHRF and is a safe treatment. However, the benefits of reducing intubation rates are only seen in moderate-to-severe patients who are undergoing HFNC treatment. In these patients, APP should be initiated early and with a target of at least 8 h/day of APP. Pillows under the body and patients-healthcare team collaboration to find the optimal position is essential to enhance patients’ adherence. Oxygenation improvement and changes in the lung ultrasound findings may help to identify those patients who are more likely to avoid the need for intubation.

show abstract

“…Moreover, awake patients with spontaneous breathing during prone positioning could lead to improved gas exchange, decreased inspiratory effort and lung stress, and attenuated systemic in ammatory response (23). A recent study also demonstrated that for patients with COVID-19induced acute hypoxemic respiratory failure (AHRF) and treated by high ow nasal cannula oxygen therapy (HFNC) and APP, APP was associated with improvements of the aeration of the dorsal lung zones (24). These might explain the effects of awake prone position in avoiding intubation.…”

Section: Discussionmentioning

confidence: 99%

Awake Prone Position in COVID-19-Related Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials

Qin

Chang

Peng

et al. 2022

Preprint

View full text Add to dashboard Cite

Background We aimed to investigate the effects of awake prone positioning (APP) in acute hypoxemic, non-intubated patients due to COVID-19 infections. Methods A collection of databases including PubMed, EMBASE, Web of Science and Cochrane Central Register were searched up to June 1, 2022. All randomized trials investigating the effects of the APP were included in the present meta-analysis. The primary outcome was intubation rate, and the secondary outcome included the length of intensive care unit (ICU) and hospital stay, and mortality. Prescribed sub-group analysis was also conducted. Results A total of 10 randomized trials enrolling 2324 patients were finally included in the present study. The results indicated APP was associated with a significant reduction of intubation rate (OR 0.77, 95% CI 0.63 to 0.93, P = 0.007). However, no differences could be observed in length of ICU stay or hospitalization, or mortality. Sub-group analysis suggested that patients in the ICU settings (OR 0.74, 95% CI 0.60 to 0.91, P = 0.004), patients whose median APP time was more than 4 hours (OR 0.77, 95% CI 0.63 to 0.93, P = 0.008), and patients with an average baseline SpO2 to FiO2 ratio less than 200 mmHg (OR 0.75, 95% CI 0.61 to 0.92) were more likely to benefit from APP with significant reduced intubation rate. Conclusion Based on the current evidence, non-intubated patients with hypoxemic respiratory failure due to COVID-19 infection conducted with APP was associated with significantly induced intubation rate. However, no differences in ICU or hospital length of stay, or mortality could be observed between APP and usual care.

show abstract

Lung ultrasound response to awake prone positioning predicts the need for intubation in patients with COVID-19 induced acute hypoxemic respiratory failure: an observational study

Cited by 15 publications

References 28 publications

Awake prone position in COVID-19 acute respiratory failure: a randomised crossover study using electrical impedance tomography

Awake prone position in COVID-19 acute respiratory failure: a randomised crossover study using electrical impedance tomography

Prone positioning of nonintubated patients with acute hypoxemic respiratory failure

Awake Prone Position in COVID-19-Related Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials

Contact Info

Product

Resources

About