Prone positioning improves oxygenation and lung recruitment in patients with SARS-CoV-2 acute respiratory distress syndrome; a single centre cohort study of 20 consecutive patients

Clarke, Jennifer; Geoghegan, Pierce; McEvoy, Natalie; Boylan, Maria; Choileáin, Orna Ní; Mulligan, Martin; Hogan, Grace; Keogh, Aoife; McElvaney, Oliver J; McElvaney, Oisín F; Bourke, John; McNicholas, Bairbre; Laffey, John G.; McElvaney, Noel G.; Curley, Gerard F.

doi:10.1186/s13104-020-05426-2

Cited by 26 publications

(44 citation statements)

References 22 publications

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“…Therefore, neonatal death is a concern for policymakers and researchers around the world. Baroni et al [ 7 ] investigated the neonatal mortality rates in Brazil, whereas Liu et al [ 8 ] and Abdul-Mumin et al [ 9 ] investigated the key reasons for neonatal death and preterm birth in China and Ghana. Regional investigations have identified that preterm birth, intrapartum complications and pneumonia (in case of China), and preterm birth complications and birth asphyxia (in case of Ghana) are the leading causes of neonatal deaths [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Association of maternal obesity with fetal and neonatal death: Evidence from South and South-East Asian countries

et al. 2021

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Background Obesity prevalence is increasing in many countries in the world, including Asia. Maternal obesity is highly associated with fetal and neonatal deaths. This study investigated whether maternal obesity is a risk factor of fetal death (measured in terms of miscarriage and stillbirth) and neonatal mortality in South and South-East Asian countries. Methods This cross-sectional study pooled the most recent Demographic and Health Surveys (DHS) from eight South and South-East Asian countries (2014–2018). Multivariate logistic regression was deployed to check the relationships between maternal obesity with fetal and neonatal deaths. Finally, multilevel logistic regression model was employed since the DHS data has a hierarchical structure. Results The pooled logistic regression model illustrated that maternal obesity is associated with higher odds of miscarriage (adjusted odds ratio [aOR]: 1.26, 95% CI: 1.20–1.33) and stillbirths (aOR: 1.46, 95% CI: 1.27–1.67) after adjustment of confounders. Children of obese mothers were at 1.18 (aOR: 1.18, 95% CI: 1.08–1.28) times greater risk of dying during the early neonatal period than mothers with a healthy weight. However, whether maternal obesity is statistically a significant risk factor for the offspring’s late neonatal deaths was not confirmed. The significant association between maternal obesity with miscarriage, stillbirth and early neonatal mortality was further confirmed by multilevel logistic regression results. Conclusion Maternal obesity in South and South-East Asian countries is associated with a greater risk of fetal and early neonatal deaths. This finding has substantial public health implications. Strategies to prevent and reduce obesity should be developed before planning pregnancy to reduce the fetal and neonatal death burden. Obese women need to deliver at the institutional facility centre that can offer obstetrics and early neonatal care.

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Section: Introductionmentioning

confidence: 99%

Association of maternal obesity with fetal and neonatal death: Evidence from South and South-East Asian countries

et al. 2021

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“…The rate of responders ranged from 9 to 77%. Seven studies provided data on static compliance of the respiratory system in supine preprone and in prone in intubated patients [ 3 ▪▪ , 35 , 37 , 42 , 45 – 48 ]. It significantly increased after a few hours in prone by 2 ml/cmH 2 O on average ( z = −2.68, P < 0.01) ( I 2 = 30%).…”

Section: Resultsmentioning

confidence: 99%

Prone position in COVID 19-associated acute respiratory failure

Kharat

Simon

Guérin

2021

Current Opinion in Critical Care

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Purpose of review Prone position has been widely used in the COVID-19 pandemic, with an extension of its use in patients with spontaneous breathing (’awake prone’). We herein propose a review of the current literature on prone position in mechanical ventilation and while spontaneous breathing in patients with COVID-19 pneumonia or COVID-19 ARDS. Recent findings A literature search retrieved 70 studies separating whether patient was intubated (24 studies) or nonintubated (46 studies). The outcomes analyzed were intubation rate, mortality and respiratory response to prone. In nonintubated patient receiving prone position, the main finding was mortality reduction in ICU and outside ICU setting. Summary The final results of the several randomized control trials completed or ongoing are needed to confirm the trend of these results. In intubated patients, observational studies showed that responders to prone in terms of oxygenation had a better survival than nonresponders.

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“…Meta-analysis of aggregate data. Among 836 initially identified articles, 23 studies fulfilled the inclusion criteria and were included in the systematic review (flowchart shown in Figure 3) (7)(8)(9)(10)(11)(12)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). The main characteristics of these studies are shown in Table I.…”

Section: Resultsmentioning

confidence: 99%

Prone Positioning in Patients With COVID-19: Analysis of Multicenter Registry Data and Meta-analysis of Aggregate Data

Kyriakoulis

Rapti

Trontzas

et al. 2021

In Vivo

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Background/Aim: Evidence suggests a beneficial effect of prone positioning (PP) in and aggregate data (PubMed/EMBASE) regarding the impact of PP on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PO 2 /FiO 2 ) in patients with COVID-19. Results: Among 121 patients (mean age±SD 59.1±10.7 years, 55% males, 57% intubated) the mean postversus pre-PP PO 2 /FiO 2 difference was: (i) 50. 4±64.3 mmHg, p<0.01, (ii) similar in awake (58.7±72.1 mmHg) versus intubated patients (44.1±57.5 mmHg, p=NS), (iii) inversely correlated with body mass index (r=-0.43, p<0.01). Metaanalysis of 23 studies (n=547, weighted age 58.3±4.1, 73% males, 59% intubated) showed a pooled PO 2 /FiO 2 difference of 61.8 [95% confidence intervals=49.9-73.6] mmHg. Metaregression analysis revealed no associations with baseline demographics, the time in PP before assessment, and the risk of bias of the studies. Conclusion: PP seems to improve oxygenation of patients with COVID-19.Prone positioning has been shown to improve oxygenation in patients with acute respiratory distress syndrome (ARDS) through effects on the mechanics and physiology of gas exchange (1-3). The available evidence suggests a survival benefit in selected patients mainly with early application of prolonged prone-positioning sessions (2, 3).Severe coronavirus disease 2019 (COVID-19) can lead to ARDS, which is characterized by high mortality (4). Preliminary evidence suggests that prone positioning might benefit oxygenation of awake patients with severe COVID-19 (5, 6). However, the effect of prone positioning in COVID-19related ARDS is still unclear. This study aimed to characterize the effect of prone positioning on oxygenation in patients with COVID-19 and ARDS, including patients in the awake status, as well as mechanically ventilated, by meta-analyzing individual and aggregate data. Materials and MethodsAnalysis of raw data. Seven groups of investigators (PROne Positioning in COvid-19 Research Consortium-7) provided raw data regarding the effect of prone positioning on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PO 2 /FiO 2 ) values in hospitalized patients with . The summary characteristics and methodology of these studies are shown in Table I. Four studies included awake patients with 8,11,12). In case of multiple sessions of prone positioning per patient and respective comparisons of PO 2 /FiO 2 values, the average PO 2 /FiO 2 difference per patient was used in the main analysis. All studies were approved by Scientific and Ethics Committees with details included in the respective publications (7)(8)(9)(10)(11)(12). The current study was approved by the

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Prone positioning improves oxygenation and lung recruitment in patients with SARS-CoV-2 acute respiratory distress syndrome; a single centre cohort study of 20 consecutive patients

Cited by 26 publications

References 22 publications

Association of maternal obesity with fetal and neonatal death: Evidence from South and South-East Asian countries

Association of maternal obesity with fetal and neonatal death: Evidence from South and South-East Asian countries

Prone position in COVID 19-associated acute respiratory failure

Prone Positioning in Patients With COVID-19: Analysis of Multicenter Registry Data and Meta-analysis of Aggregate Data

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