Prone positioning in patients treated with non-invasive ventilation for COVID-19 pneumonia in an Italian emergency department

Abstract

<jats:p>We report the experience of prone ventilation in selected patients treated with helmet non-invasive ventilation (NIV) continuous positive airway pressure (CPAP) for acute respiratory failure in COVID-19 pneumonia. Preliminary results showed an improvement in the PaO<jats:sub>2</jats:sub> value and PaO<jats:sub>2</jats:sub>/FiO<jats:sub>2</jats:sub> ratio after 1 hour of prone ventilation. No variation of the lung ultrasound pattern before and after prone ventilation has been detected. At the time of writing, we attempted proning with helmet NIV CPAP in 10 patients. In 4 out of 10 patients, the attempt failed due to lack of compliance of the patient, scarce pain control even with ongoing treatment and refusal by the patient to prone positioning.</jats:p>

Awake prone positioning for COVID-19 hypoxemic respiratory failure: A rapid review

“…From this, 162 articles were selected for full text review and 35 articles met inclusion criteria and were included in the final rapid review synthesis. A total of 35 studies (including 12 prospective cohorts, 18 retrospective cohorts, and 5 case reports) with 414 patients were synthesized (see Table 1 and Table 2 ) [ [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] ]. Twenty-nine of these studies ( n = 364 patients; 11 prospective cohorts, 13 retrospective cohorts, 5 case reports) report on the use of awake prone positioning in COVID-19 patients [ [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [19] , [20] , [21] , [24] , [25] , [26] , [27] , [28] , [29] , [31] , [32] , [33] , [35] , [36] , [37] , [38] , [39] , …”

“…Only one study included data from a control group [ 44 ]. Seventeen studies (128 patients) were conducted exclusively within the ICU [ 12 , [16] , [17] , [18] , [19] , 22 , 23 , 25 , [29] , [30] , [31] , 34 , 35 , 37 , [40] , [41] , [42] ], two in the emergency department (60 patients) [ 10 , 13 ], eight exclusively on a non-ICU hospital ward (104 patients) [ 14 , 20 , 21 , 27 , 28 , 32 , 33 , 38 ], and two studies included patients in multiple settings (73 patients) [ 15 , 36 ]. The setting was not reported in 6 studies (49 patients) [ 11 , 24 , 26 , 39 , 43 , 44 ].…”

“…The setting was not reported in 6 studies (49 patients) [ 11 , 24 , 26 , 39 , 43 , 44 ]. The frequency and duration of prone positioning was protocolized in only 15 studies (223 patients) [ 10 , [14] , [15] , [16] , 18 , 19 , 25 , 26 , 28 , 30 , 31 , 38 , 39 , 43 , 44 ]. The duration of prone positioning sessions varied from <1 h to >18 h ( Tables 1 and 2) and was not reported in three studies [ 13 , 26 , 27 ].…”

“…Key details to offer this intervention safely such as the frequency, duration and adverse events were often not described or provided in limited detail. In six studies, awake prone positioning was not tolerated by some patients for even short durations [ 10 , 18 , 20 , 24 , 34 , 36 ]. Invasively ventilated patients with ARDS require greater than 12 h of prone positioning to receive a mortality benefit from prone positioning, which often requires sedation and paralysis to be tolerated [ 45 , 46 ].…”

Behandlungsempfehlungen zur Beatmung von COVID‑19-Patienten

“…Das in vielen Fällen sehr gute Ansprechen auf die Bauchlage bei invasiv beatmeten COVID‑19-Patienten hat zu Versuchen geführt, die Bauchlage auch bei Patienten in früheren Krankheitsphasen zu etablieren. So wurden Patienten unter Sauerstofftherapie und NIV [ 17 ] aufgefordert, möglichst lange Zeit auf dem Bauch liegend zu verbringen. Bei teilweise erstaunlich guter Toleranz der Bauchlagerung wurden eine Verbesserung der Oxygenierung berichtet [ 18 , 19 ].…”