Prone Position Reduces Spontaneous Inspiratory Effort in Patients with Acute Respiratory Distress Syndrome: A Bicenter Study

Yoshida, Toyohiko; Tanaka, Aiko; Roldán, Rollin; Quispe, Rocío; Taenaka, Hiroki; Uchiyama, Akinori; Fujino, Yuji

doi:10.1164/rccm.202012-4509le

Cited by 26 publications

(25 citation statements)

References 9 publications

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“…During prone positioning, all patients were paralyzed and ventilated in volume-controlled ventilation. Recent evidence [32] show that spontaneous breathing could be beneficial during prone position and the effect of spontaneous breathing during prone positioning in COVID-19 patients has to be explored. Moreover, despite no differences were found in driving pressure change, PEEP and recruitment may have played a role in some patients.…”

Section: Discussionmentioning

confidence: 99%

“…The main characteristics of the population are summarized in Table 1. Age was 66 years [59-72], 152 patients (79.6%) were males, SAPS II and SOFA scores at admission were 38 [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] and 5 [3][4][5][6][7], respectively. Hypertension was the most common comorbidity (104/191, 54.5%).…”

Section: Main Characteristics Of the Samplementioning

confidence: 99%

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Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study

Scaramuzzo

Gamberini

Tonetti

et al. 2021

Ann. Intensive Care

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Background Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (≥ median PaO2/FiO2 variation) or non-responders (< median PaO2/FiO2 variation) based on the PaO2/FiO2 percentage change between pre-proning and 1 to 3 h after re-supination in the first prone positioning session. Differences among the groups in physiological variables, complication rates and outcome were evaluated. A competing risk regression analysis was conducted to evaluate if PaO2/FiO2 response after the first pronation cycle was associated to liberation from mechanical ventilation. Results The median PaO2/FiO2 variation after the first PP cycle was 49 [19–100%] and no differences were found in demographics, comorbidities, ventilatory treatment and PaO2/FiO2 before PP between responders (96/191) and non-responders (95/191). Despite no differences in ICU length of stay, non-responders had a higher rate of tracheostomy (70.5% vs 47.9, P = 0.008) and mortality (53.7% vs 33.3%, P = 0.006), as compared to responders. Moreover, oxygenation response after the first PP was independently associated to liberation from mechanical ventilation at 28 days and was increasingly higher being higher the oxygenation response to PP. Conclusions Sustained oxygenation improvement after first PP session is independently associated to improved survival and reduced duration of mechanical ventilation in critically ill COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

Section: Main Characteristics Of the Samplementioning

confidence: 99%

Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study

Scaramuzzo

Gamberini

Tonetti

et al. 2021

Ann. Intensive Care

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“…During the coronavirus pandemic, the results of some studies showed that the prone position was more widely used regardless of the severity of ARDS [ 14 ] and it was also used in non-intubated patients [ 15 ]. In fact, the prone position has been shown to decrease inspiratory effort and lung stress and to improve gas exchange while attenuating systemic inflammation in patients with ARDS [ 16 ]; the same effects might apply in awake patients.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

“…Although it has been recently shown that the prone position may reduce inspiratory effort during spontaneous breathing in non-ECMO ARDS patients [ 16 ], the prone position is usually associated with the use of neuromuscular blockade and deeper sedation, avoiding spontaneous breathing. Conversely, the European Life Support Organization guidelines recommend an early reduction in sedation levels and a switch to spontaneous breathing after 24–48 h of ECMO initiation [ 28 ].…”

Section: Which Ecmo Patients Should Be Proned?mentioning

confidence: 99%

To prone or not to prone ARDS patients on ECMO

2021

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This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .

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“…Nasal irrigation, sea water nasal rinse with, and without, oral gargling with antimicrobial mouth washes reduced clinical severity and symptom duration [11,12], prevented upper respiratory infections [12,13] and provided benefi t for individuals infected with rhinovirus, enterovirus, infl uenza A virus, and coronavirus families and reduced transmission to other close contacts [13].…”

Section: Upper Respiratory Care: Reducing Complications Transmission Risk and Duration Of Infectionmentioning

confidence: 99%

Inclusion of steps to enhance mucus clearance may provide benefit for symptomatic COVID patients by reducing total viral load, time to recovery, risk of complications and transmission risk

John¹,

Charles²

2021

Open J Asthma

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Prone Position Reduces Spontaneous Inspiratory Effort in Patients with Acute Respiratory Distress Syndrome: A Bicenter Study

Cited by 26 publications

References 9 publications

Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study

Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study

To prone or not to prone ARDS patients on ECMO

Inclusion of steps to enhance mucus clearance may provide benefit for symptomatic COVID patients by reducing total viral load, time to recovery, risk of complications and transmission risk

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