Prone position reduces the risk of patients with mild or moderate COVID-19 progressing to severe or even critical cases: a retrospective study

Xu, Chuan-cai; Xu, Jianhua; Wang, Xiaofei; Shao, Meng; Ye, Sheng; Tang, Xiaomiao; Lei, Wei

doi:10.1186/s40001-022-00776-y

Cited by 2 publications

(2 citation statements)

References 43 publications

(69 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies indicate mechanical ventilation in a prone position increases the oxygenation of the critically ill patient with COVID-19, 18,19 and it is associated with a lower risk of progression from moderate to severe or critical cases. 20 Another strategy to prevent lung injury caused by MV is the administration of exogenous surfactant. Surfactant is a phospholipid substance produced by type II epithelial cells, in which, its main function is to reduce surface tension at the air-liquid interface inside the alveoli.…”

Section: Impact Statementmentioning

confidence: 99%

See 1 more Smart Citation

Exogenous surfactant reduces inflammation and redox imbalance in rats under prone or supine mechanical ventilation

Souza

Diedrich

Machado-Junior

et al. 2023

Exp Biol Med (Maywood)

View full text Add to dashboard Cite

Mechanical ventilation (MV) is a lifesaving therapy for patients with acute or chronic respiratory failure. Despite, it can also cause lung injury by inducing or worsening inflammatory responses and oxidative stress. Several clinical approaches have protective effects on the lungs, including the prone position and exogenous surfactant; however, few studies have evaluated the association between the two strategies, especially in individuals without previous lung injury. We tested the hypothesis that the effects of the homogenization in lung aeration caused by the prone position in association with the anti-inflammatory properties of exogenous surfactant pre-treatment could have a cumulative protective effect against ventilator-induced lung injury. Therefore, Wistar rats were divided into four experimental groups: Mechanical Ventilation in Supine Position (MVSP), Mechanical Ventilation in Prone position (MVPP), Mechanical Ventilation in Supine Position + surfactant (MVSPS), and Mechanical Ventilation in Prone Position + Surfactant (MVPPS). The intranasal instillation of a porcine surfactant (Curosurf®) was performed in the animals of MVSPS and MVPPS 1 h before the MV, all the rats were subjected to MV for 1 h. The prone position in association with surfactant decreased mRNA expression levels of pro-inflammatory cytokines in ventilated animals compared to the supine position; in addition, the NfκB was lower in MVPP, MVSPS and MVPPS when compared to MVSP. However, it had no effects on oxidative stress caused by MV. Pre-treatment with exogenous surfactant was more efficient in promoting lung protection than the prone position, as it also reduced oxidative damage in the lung parenchyma. Nevertheless, the surfactant did not cause additional improvements in most parameters that were also improved by the prone position. Our results indicate that the pre-treatment with exogenous surfactant, regardless of the position adopted in mechanical ventilation, preserves the original lung histoarchitecture, reduces redox imbalance, and reduces acute inflammatory responses caused by mechanical ventilation in healthy adult Wistar rats.

show abstract

Section: Impact Statementmentioning

confidence: 99%