Short-term outcomes of 50 patients with acute respiratory distress by COVID-19 where prone positioning was used outside the ICU

Taboada, Manuel; Rodríguez, Núria; Riveiro, Vanessa; Abelleira, Romina; Ricoy, Jorge; Lama, Adriana; Casal, Ana; Lourido, Tamara; Rábade, Carlos; Molinos, Sònia; Díaz, José; Valdés, Luís; Pose, Antonio; Baluja, Aurora; Álvarez, Julián

doi:10.1016/j.jclinane.2020.110028

Cited by 10 publications

(8 citation statements)

References 4 publications

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“…The prone position provides more uniform lung perfusion, shifting ventilation to well-perfused lung segments, and recruits dependent atelectatic regions of lung ( 7 – 9 ). Physiological alterations associated with the prone position would foreseeably also apply to spontaneously breathing patients, and evidence from small observational studies suggests that prone positioning in nonintubated patients is feasible and associated with improved oxygenation ( 10 – 13 ). However, it remains unknown if a prone ventilation strategy is definitively beneficial for nonintubated hypoxic patients with COVID-19, and this question has stimulated interest in the conduct of rigorous randomized controlled trials (RCTs) ( 14 – 16 ).…”

mentioning

confidence: 99%

Awake Prone Positioning Strategy for Nonintubated Hypoxic Patients with COVID-19: A Pilot Trial with Embedded Implementation Evaluation

Taylor¹,

Bundy

Smith³

et al. 2021

Annals ATS

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Rationale: Prone positioning is an appealing therapeutic strategy for nonintubated hypoxic patients with coronavirus disease (COVID-19), but its effectiveness remains to be established in randomized controlled trials. Objectives: To identify contextual factors relevant to the conduct of a definitive clinical trial evaluating a prone positioning strategy for nonintubated hypoxic patients with COVID-19. Methods: We conducted a cluster randomized pilot trial at a quaternary care teaching hospital. Five inpatient medical service teams were randomly allocated to two treatment arms: 1 ) usual care (UC), consisting of current, standard management of hypoxia and COVID-19; or 2 ) the Awake Prone Positioning Strategy (APPS) plus UC. Included patients had positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing or suspected COVID-19 pneumonia and oxygen saturation less than 93% or new oxygen requirement of 3 L per minute or greater and no contraindications to prone positioning. Oxygenation measures were collected within 48 hours of eligibility and included nadir oxygen saturation to fraction of inspired oxygen (S/F) ratio and time spent with S/F ratio less than 315. Concurrently, we conducted an embedded implementation evaluation using semistructured interviews with clinician and patient participants to determine contextual factors relevant to the successful conduct of a future clinical trial. The primary outcomes were drawn from an implementation science framework including acceptability, adoption, appropriateness, effectiveness, equity, feasibility, fidelity, and penetration. Results: Forty patients were included in the cluster randomized trial. Patients in the UC group ( n = 13) had a median nadir S/F ratio over the 48-hour study period of 216 (95% confidence interval [95% CI], 95–303) versus 253 (95% CI, 197–267) in the APPS group ( n = 27). Patients in the UC group spent 42 hours (95% CI, 13–47) of the 48-hour study period with an S/F ratio below 315 versus 20 hours (95% CI, 6–39) for patients in the APPS group. Mixed-methods analyses uncovered several barriers relevant to the conduct of a successful definitive randomized controlled trial, including low adherence to prone positioning, large differences between physician-recommended and patient-tolerated prone durations, and diffusion of prone positioning into usual care. Conclusions: A definitive trial evaluating the effect of prone positioning in nonintubated patients with COVID-19 is warranted, but several barriers must be addressed to ensure that the results of such a trial are informative and readily translated into practice.

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mentioning

confidence: 99%

Awake Prone Positioning Strategy for Nonintubated Hypoxic Patients with COVID-19: A Pilot Trial with Embedded Implementation Evaluation

Taylor¹,

Bundy

Smith³

et al. 2021

Annals ATS

View full text Add to dashboard Cite

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“…Out of 21 included studies, 5 were from Italy, 17 – 20 , 29 3 each from China 12 , 13 , 27 and Spain, 24 – 26 2 each from France, 14 , 28 Iran, 15 , 16 New York, 21 , 22 United Kingdom, 31 , 32 and 1 each from Singapore 23 and Maryland. 30 All included studies were done in different hospitals and universities except two studies reported from the same hospital and also done during the overlapping time period, 25 , 26 thereby causing duplicate analysis of the same cohort.…”

Section: Resultsmentioning

confidence: 99%

Awake Proning for Nonintubated Adult Hypoxic Patients with COVID-19: A Systematic Review of the Published Evidence

Parashar

Karthik

Gupta

et al. 2021

Indian Journal of Critical Care Medicine

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Objective: Awake proning is an intervention that is being advocated for COVID-19 patients and has been suggested to improve the oxygenation, thereby decreasing oxygen requirements. We performed this systematic review with the aim of appraising the latest published evidence on the clinical effectiveness of awake proning in COVID-19 patients. Data sources: PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, and one trial registry were searched until September 23, 2020, for studies on the use of awake proning for nonintubated COVID-19 patients. Study selection: Published or in-press peer-reviewed randomized control trials, case-control trials, and prospective or retrospective cohort studies in English language only were sought, assessing the effectiveness of awake proning for nonintubated patients diagnosed with COVID-19. Data results: We included 21 published studies (19 single arm and 2 with comparison group). Twenty-three registered clinical trials were identified. No randomized clinical trial has been published so far. Conclusions: Awake proning is probably safe and effective in enhancing oxygenation in nonintubated COVID-19 patients; however, there is insufficient evidence. Further high-quality clinical trials are urgently needed to assess the effectiveness of awake proning on a variety of patient-centered outcomes. How to cite this article: Parashar S, Karthik AR, Gupta R, Malviya D. Awake Proning for Nonintubated Adult Hypoxic Patients with COVID-19: A Systematic Review of the Published Evidence. Indian J Crit Care Med 2021;25(8):906–916.

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“… 6 Evidence from small observational and retrospective studies suggests that prone positioning in nonintubated patients is feasible and associated with improved oxygenation. 10 , 11 , 12 , 13 , 14 , 7 , 8 , 9 …”

Section: Flipped Physiologymentioning

confidence: 99%

“…Although there are differences in the inclusion criteria of the available research on awake proning for suspected COVID-19–related hypoxia, typically those who are eligible will be able to protect their own airway, will require supplemental oxygen, will be hemodynamically stable, oriented, and physically capable of assuming the prone position independently (or with minimal assistance for managing attachments such as intravenous lines and catheters). 10 , 11 , 12 , 13 , 14 , 7 , 8 , 9 …”

Section: Who How and When Not To Pronementioning

confidence: 99%

Commentary on “Prone Positioning of Patients With Coronavirus Disease 2019 Who Are Nonintubated in Hypoxic Respiratory Distress”

Picard¹,

Douma²

2021

Journal of Emergency Nursing

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Short-term outcomes of 50 patients with acute respiratory distress by COVID-19 where prone positioning was used outside the ICU

Cited by 10 publications

References 4 publications

Awake Prone Positioning Strategy for Nonintubated Hypoxic Patients with COVID-19: A Pilot Trial with Embedded Implementation Evaluation

Awake Prone Positioning Strategy for Nonintubated Hypoxic Patients with COVID-19: A Pilot Trial with Embedded Implementation Evaluation

Awake Proning for Nonintubated Adult Hypoxic Patients with COVID-19: A Systematic Review of the Published Evidence

Commentary on “Prone Positioning of Patients With Coronavirus Disease 2019 Who Are Nonintubated in Hypoxic Respiratory Distress”

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