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European Respiratory Review : An... Jun 2023Awake prone positioning (APP) of patients with acute hypoxaemic respiratory failure gained considerable attention during the early phases of the coronavirus disease 2019... (Review)
Review
Awake prone positioning (APP) of patients with acute hypoxaemic respiratory failure gained considerable attention during the early phases of the coronavirus disease 2019 (COVID-19) pandemic. Prior to the pandemic, reports of APP were limited to case series in patients with influenza and in immunocompromised patients, with encouraging results in terms of tolerance and oxygenation improvement. Prone positioning of awake patients with acute hypoxaemic respiratory failure appears to result in many of the same physiological changes improving oxygenation seen in invasively ventilated patients with moderate-severe acute respiratory distress syndrome. A number of randomised controlled studies published on patients with varying severity of COVID-19 have reported apparently contrasting outcomes. However, there is consistent evidence that more hypoxaemic patients requiring advanced respiratory support, who are managed in higher care environments and who can be prone for several hours, benefit most from APP use. We review the physiological basis by which prone positioning results in changes in lung mechanics and gas exchange and summarise the latest evidence base for APP primarily in COVID-19. We examine the key factors that influence the success of APP, the optimal target populations for APP and the key unknowns that will shape future research.
Topics: Humans; COVID-19; Wakefulness; Prone Position; Respiratory Insufficiency; Lung; Respiratory Distress Syndrome; Patient Positioning
PubMed: 37137508
DOI: 10.1183/16000617.0245-2022 -
Intensive Care Medicine Dec 2022
Topics: Humans; Prone Position; Wakefulness; Patient Positioning; SARS-CoV-2; Respiratory Insufficiency
PubMed: 36151334
DOI: 10.1007/s00134-022-06893-w -
Respiratory Care May 2021
Topics: Humans; Lung; Noninvasive Ventilation; Patient Positioning; Prone Position; Respiratory Distress Syndrome
PubMed: 33931520
DOI: 10.4187/respcare.09131 -
Journal of Forensic and Legal Medicine Oct 2020Law-enforcement often uses forensic restraints to control individuals and often these individuals are placed in positions and with various amounts of weight used to hold... (Review)
Review
Law-enforcement often uses forensic restraints to control individuals and often these individuals are placed in positions and with various amounts of weight used to hold them in place. There has been a moderate amount of research performed on humans in this field of study to assess the physiologic impact of the positions and weight on ventilatory and cardiovascular parameters. This review discusses the scientific medical literature on the use of restraints and restraint position including the use of weight force and aggregates the findings in specific physiologic areas, such as impact on blood pressure, heart rate, and ventilatory parameters.
Topics: Asphyxia; Blood Pressure; Cardiac Output; Forensic Sciences; Heart Rate; Humans; Oxygen Consumption; Prone Position; Respiratory Function Tests; Restraint, Physical
PubMed: 32956928
DOI: 10.1016/j.jflm.2020.102056 -
The American Journal of Emergency... Nov 2020The ongoing pandemic of COVID-19 brought to the fore prone positioning as treatment for patients with acute respiratory failure. With the increasing number of patients... (Review)
Review
INTRODUCTION
The ongoing pandemic of COVID-19 brought to the fore prone positioning as treatment for patients with acute respiratory failure. With the increasing number of patients in prone position, both spontaneously breathing and mechanically ventilated, cardiac arrest in this position is more likely to occur. This scoping review aimed to summarize the available evidence on cardiopulmonary resuscitation in prone position ('reverse CPR') and knowledge or research gaps to be further evaluated. The protocol of this scoping review was prospectively registered on 10th May 2020 in Open Science Framework (https://osf.io/nfuh9).
METHODS
We searched PubMed, EMBASE, MEDLINE and pre-print repositories (bioRxiv and medRxiv) for simulation, pre-clinical and clinical studies on reverse CPR until 31st May 2020.
RESULTS
We included 1 study on manikins, 31 case reports (29 during surgery requiring prone position) and 2 nonrandomized studies describing reverse CPR. No studies were found regarding reverse CPR in patients with COVID-19.
CONCLUSIONS
Even if the algorithms provided by the guidelines on basic and advanced life support remain valid in cardiac arrest in prone position, differences exist in the methods of performing CPR. There is no clear evidence of superiority in terms of effectiveness of reverse compared to supine CPR in patients with cardiac arrest occurring in prone position. The quality of evidence is low and knowledge gaps (e.g. protocols, training of healthcare personnel, devices for skill acquisition) should be fulfilled by further research. Meanwhile, a case-by-case evaluation of patient and setting characteristics should guide the decision on how to start CPR in such cases.
Topics: COVID-19; Cardiopulmonary Resuscitation; Heart Arrest; Humans; Patient Positioning; Prone Position
PubMed: 33046293
DOI: 10.1016/j.ajem.2020.08.097 -
Critical Care Medicine Jan 2023Prone positioning and venovenous extracorporeal membrane oxygenation (ECMO) are both useful interventions in acute respiratory distress syndrome (ARDS). Combining the...
OBJECTIVES
Prone positioning and venovenous extracorporeal membrane oxygenation (ECMO) are both useful interventions in acute respiratory distress syndrome (ARDS). Combining the two therapies is feasible and safe, but the effectiveness is not known. Our objective was to evaluate the potential survival benefit of prone positioning in venovenous ECMO patients cannulated for COVID-19-related ARDS.
DESIGN
Retrospective analysis of a multicenter cohort.
PATIENTS
Patients on venovenous ECMO who tested positive for severe acute respiratory syndrome coronavirus 2 by reverse transcriptase polymerase chain reaction or with a diagnosis on chest CT were eligible.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
All patients on venovenous ECMO for respiratory failure in whom prone position status while on ECMO and in-hospital mortality were known were included. Of 647 patients in 41 centers, 517 were included. Median age was 55 (47-61), 78% were male and 95% were proned before cannulation. After cannulation, 364 patients (70%) were proned and 153 (30%) remained in the supine position for the whole ECMO run. There were 194 (53%) and 92 (60%) deaths in the prone and the supine groups, respectively. Prone position on ECMO was independently associated with lower in-hospital mortality (odds ratio = 0.49 [0.29-0.84]; p = 0.010). In 153 propensity score-matched pairs, mortality rate was 49.7% in the prone position group versus 60.1% in the supine position group (p = 0.085). Considering only patients alive at decannulation, propensity-matched proned patients had a significantly lower mortality rate (22.4% vs 37.8%; p = 0.029) than nonproned patients.
CONCLUSIONS
Prone position may be beneficial in patients supported by venovenous ECMO for COVID-19-related ARDS but more data are needed to draw definitive conclusions.
Topics: Humans; Male; Middle Aged; Female; Extracorporeal Membrane Oxygenation; Prone Position; Retrospective Studies; COVID-19; Respiratory Distress Syndrome
PubMed: 36519982
DOI: 10.1097/CCM.0000000000005714 -
Journal of Obstetric, Gynecologic, and... Jan 2023To identify and synthesize the available evidence on the effect of different positions (prone, supine, and right and left lateral) on nonautonomic outcomes for preterm... (Review)
Review
OBJECTIVE
To identify and synthesize the available evidence on the effect of different positions (prone, supine, and right and left lateral) on nonautonomic outcomes for preterm infants admitted to the NICU.
DATA SOURCES
We searched the CINAHL, MEDLINE, Scopus, and Cochrane databases for reports of primary research studies using a three-step strategy. We also searched for gray literature and reviewed the reference lists of retrieved articles.
STUDY SELECTION
We included reports of quantitative studies published in English from database inception through February 2022 that focused on positioning and nonautonomic outcomes (pain, comfort, skin integrity, behavioral state, and sleep quality and duration) for preterm infants in the NICU. Two authors independently screened titles and abstracts and assessed articles in full text against the inclusion criteria.
DATA EXTRACTION
Two authors independently extracted the data from the full-text articles using a standardized data extraction tool. We synthesized the data narratively because of the different designs and outcome measures among the included studies.
DATA SYNTHESIS
From a total of 550 records initially screened, we included 17 articles in our review. In the included articles, prone positioning improved sleep quality and duration, whereas supine positioning was associated with increased awakenings and activity. Infants demonstrated fewer self-regulatory behaviors in the prone position compared to supine or side-lying and were less stressed in the prone position. We found minimal evidence on the effect of positioning on skin integrity or pain.
CONCLUSION
There is limited good-quality evidence on the effect of positioning on nonautonomic outcomes in preterm infants. To inform clinical practice, high-quality randomized controlled trials focused on the positioning of premature infants are warranted.
Topics: Humans; Infant; Infant, Newborn; Hospitalization; Infant, Premature; Patient Positioning; Prone Position
PubMed: 36309067
DOI: 10.1016/j.jogn.2022.09.007 -
Respiratory Care Dec 2021Prone positioning is a therapy utilized globally to improve gas exchange, minimize ventilator-induced lung injury, and reduce mortality in ARDS, particularly during the... (Review)
Review
BACKGROUND
Prone positioning is a therapy utilized globally to improve gas exchange, minimize ventilator-induced lung injury, and reduce mortality in ARDS, particularly during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Whereas the respiratory benefits of prone positioning in ARDS have been accepted, the concurrent complications could be undervalued. Therefore, this study aimed to identify the adverse events (AEs) related to prone positioning in ARDS and, secondarily, to collect strategies and recommendations to mitigate these AEs.
METHODS
In this scoping review, we searched recommendation documents and original studies published between June 2013 and November 2020 from 6 relevant electronic databases and the websites of intensive care societies.
RESULTS
We selected 41 documents from 121 eligible documents, comprising 13 recommendation documents and 28 original studies (involving 1,578 subjects and 994 prone maneuvers). We identified > 40 individual AEs, and the highest-pooled occurrence rates were those of severe desaturation (37.9%), barotrauma (30.5%), pressure sores (29.7%), ventilation-associated pneumonia (28.2%), facial edema (16.7%), arrhythmia (15.4%), hypotension (10.2%), and peripheral nerve injuries (8.1%). The reported mitigation strategies during prone positioning included alternate face rotation (18 [43.9%]), repositioning every 2 h (17 [41.5%]), and the use of pillows under the chest and pelvis (14 [34.1%]). The reported mitigation strategies for performing the prone maneuver comprised one person being at the headboard (23 [56.1%]), the use of a pre-maneuver safety checklist (18 [43.9%]), vital sign monitoring (15 [36.6%]), and ensuring appropriate ventilator settings (12 [29.3%]).
CONCLUSIONS
We identified > 40 AEs reported in prone positioning ARDS studies, including additional AEs not yet reported by previous systematic reviews. The pooled AE proportions collected in this review could guide research and clinical practice decisions, and the strategies to mitigate AEs could promote future consensus-based recommendations.
Topics: Adult; COVID-19; Humans; Patient Positioning; Prone Position; Respiration, Artificial; Respiratory Distress Syndrome; SARS-CoV-2
PubMed: 34301802
DOI: 10.4187/respcare.09194 -
The European Respiratory Journal Feb 2022https://bit.ly/3m3NeAx
https://bit.ly/3m3NeAx
Topics: COVID-19; Humans; Patient Positioning; Prone Position; Respiratory Insufficiency; SARS-CoV-2
PubMed: 34649977
DOI: 10.1183/13993003.02416-2021 -
An evidence-based general anaesthesia and prone position nursing checklist: Development and testing.Nursing Open Mar 2023Prone positioning during general anaesthesia is one of the most difficult practices for the perioperative nurse. Patients in this position are vulnerable to many...
AIM
Prone positioning during general anaesthesia is one of the most difficult practices for the perioperative nurse. Patients in this position are vulnerable to many preventable complications. However, no studies have developed an evidence-based tool to improve nursing practice during general anaesthesia and prone positioning. This study aimed to develop and test a general anaesthesia and prone position nursing checklist for use by the circulating nurse.
DESIGN
A prospective pre-post study was performed between October 2020 and March 2021.
METHODS
The WHO checklist development model and evidence-based methods guided the checklist development process. We prospectively observed circulating nurses that attended to prone general anaesthesia during posterior lumbar spine surgery for 3 months before and after the introduction of the general anaesthesia and prone position nursing risk checklist. The main outcomes were successful delivery of essential prone positional nursing practices during each surgery and the nurse's opinion of the checklist's efficacy and utility.
RESULTS
A general anaesthesia and prone position nursing checklist comprised of 4 pause points and 22 necessary nursing practices was developed. Seventy-two nurses participated in this study. Use of the checklist significantly increased the average performance of essential practices during each surgery from 72.72%-95.45%. Three measures had a compliance rate of 100%. The delivery rate of 14 measures was significantly improved, 91.7% of nurses considered the checklist easy to use, and 94.4% nurses would want the checklist to be used if they underwent a prone position and general anaesthesia operation.
Topics: Humans; Checklist; Prone Position; Prospective Studies; Anesthesia, General; Patient Positioning
PubMed: 36168198
DOI: 10.1002/nop2.1382