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Journal of Cardiothoracic and Vascular... Mar 2019
Review
Topics: Aged, 80 and over; Echocardiography, Transesophageal; Humans; Intraoperative Complications; Male; Monitoring, Intraoperative; Prone Position
PubMed: 30269891
DOI: 10.1053/j.jvca.2018.08.207 -
Chest Jun 2023
Topics: Humans; Prone Position; Prospective Studies; Patient Positioning
PubMed: 37295894
DOI: 10.1016/j.chest.2023.02.042 -
Medicina Intensiva Nov 2023
Topics: Prone Position; Humans; Respiratory Distress Syndrome; Patient Positioning; Respiration, Artificial
PubMed: 37775471
DOI: 10.1016/j.medine.2023.07.015 -
British Journal of Anaesthesia Feb 2022Prone positioning in non-intubated spontaneously breathing patients is becoming widely applied in practice alongside noninvasive respiratory support. This systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Prone positioning in non-intubated spontaneously breathing patients is becoming widely applied in practice alongside noninvasive respiratory support. This systematic review and meta-analysis evaluates the effect, timing, and populations that might benefit from awake proning regarding oxygenation, mortality, and tracheal intubation compared with supine position in hypoxaemic acute respiratory failure.
METHODS
We conducted a systematic literature search of PubMed/MEDLINE, Cochrane Library, Embase, CINAHL, and BMJ Best Practice until August 2021 (International Prospective Register of Systematic Reviews [PROSPERO] registration: CRD42021250322). Studies included comprise least-wise 20 adult patients with hypoxaemic respiratory failure secondary to acute respiratory distress syndrome or coronavirus disease (COVID-19). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and study quality was assessed using the Newcastle-Ottawa Scale and the Cochrane risk-of-bias tool.
RESULTS
Fourteen studies fulfilled the selection criteria and 2352 patients were included; of those patients, 99% (n=2332/2352) had COVID-19. Amongst 1041 (44%) patients who were placed in the prone position, 1021 were SARS-CoV-2 positive. The meta-analysis revealed significant improvement in the PaO/FiO ratio (mean difference -23.10; 95% confidence interval [CI]: -34.80 to 11.39; P=0.0001; I=26%) after prone positioning. In patients with COVID-19, lower mortality was found in the group placed in the prone position (150/771 prone vs 391/1457 supine; odds ratio [OR] 0.51; 95% CI: 0.32-0.80; P=0.003; I=48%), but the tracheal intubation rate was unchanged (284/824 prone vs 616/1271 supine; OR 0.72; 95% CI: 0.43-1.22; P=0.220; I=75%). Overall proning was tolerated for a median of 4 h (inter-quartile range: 2-16).
CONCLUSIONS
Prone positioning can improve oxygenation amongst non-intubated patients with acute hypoxaemic respiratory failure when applied for at least 4 h over repeated daily episodes. Awake proning appears safe, but the effect on tracheal intubation rate and survival remains uncertain.
Topics: COVID-19; Humans; Noninvasive Ventilation; Patient Positioning; Prone Position; Respiratory Insufficiency; Wakefulness
PubMed: 34774295
DOI: 10.1016/j.bja.2021.09.031 -
Prone position protocol in awake COVID-19 patients: A prospective study in the emergency department.Journal of Infection and Public Health Apr 2022Limited effective interventions exist in the emergency department (ED) for COVID-19 patients with respiratory failure. One of the promising interventions is the prone...
BACKGROUND
Limited effective interventions exist in the emergency department (ED) for COVID-19 patients with respiratory failure. One of the promising interventions is the prone position, which has been proven to improve oxygenation in ICU settings. Here, we aimed to describe and assess the utility of the prone position in awake non-intubated adult patients in EDs during the COVID-19 pandemic.
METHODS
We conducted a prospective cohort study of hypoxic COVID-19 adult patients who presented to our emergency department. We collected the data from June to the end of August 2020, including vital signs and physiological and clinical parameters before and after completing the four-hour prone position protocol. The main outcomes assessed were improvement in oxygenation, respiratory rate, respiratory distress score, ICU admission, and intubation. Oxygenation was calculated based on the standard pulse oximeter saturation [SpO]/fractional concentration of oxygen in inspired air (FiO).
RESULTS
The study included 49 patients (81.63% men; mean age, 53.37 ± 11 years). The mean oxygen saturation during the triage was 84.49% ± 7.98 on room air. After completing of the four-hour prone protocol, the mean SpO/FiO ratio increased from 1.62 ± 0.78-1.99 ± 0.75 (p < 0.0001). The respiratory rate decreased from 32.45 ± 5.24-26.29 ± 5.40 (p < 0.0001). Respiratory distress scores decreased after changing patients' positions (p < 0.0001). Twenty-four patients (48.9%) were admitted to the ICU, 6 patients were intubated (12.2%), and 7 (14.3%) died in the hospital.
CONCLUSION
After applying the prone position in the ED, significant and immediate improvement was observed in oxygenation, respiratory rate, respiratory distress, and carbon dioxide levels. A linear relationship between the level of improvement in oxygenation and reduction in ICU admission was observed. However, further studies recommended to assess the advantage of the procedure in terms of ICU admission, intubation, or mortality.
Topics: Adult; COVID-19; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Pandemics; Prone Position; Prospective Studies; Respiratory Distress Syndrome; Wakefulness
PubMed: 35272978
DOI: 10.1016/j.jiph.2022.02.008 -
Enfermeria Intensiva 2008Acute respiratory distress syndrome (ARDS) has been a subject of research in the recent decades since it was defined in the seventies. ARDS is now known to be triggered... (Review)
Review
Acute respiratory distress syndrome (ARDS) has been a subject of research in the recent decades since it was defined in the seventies. ARDS is now known to be triggered by pulmonary and non-pulmonary insults which allow chemical agents to be released in the lungs. The resulting damage to the alveolar-capillary membrane causes an impaired ventilation and oxygenation. The aim of the present bibliographic review is to describe all the theories that have been proposed since 1974 to explain how the prone position enhances oxygenation in ARDS patients. Current thought amongst researchers includes how the prone position could improve the functional residual capacity, the ventilation/perfusion ratio, the mechanics of lung, diaphragmatic and thoracic movement, the ability to clear secretions, and the release of the lungs from weight of the mediastinal structures. The literature suggests using the prone position in the early stages of ARDS; however it has not been concluded how long prone position should be maintained in order to achieve the best oxygenation levels. The results of the studies reviewed revealed that 50-80% of the patients experienced significant improvement of oxygenation with the prone position. However, no study has shown that the prone position significantly reduces mortality. It is concluded that further investigations are necessary to understand how the prone position affects the lungs, what group of patients respond to this treatment, what duration and frequency of proning is most beneficial to reduce mortality, and how to effectively nurse patients who are in the prone position.
Topics: Humans; Prone Position; Respiratory Distress Syndrome
PubMed: 18570829
DOI: 10.1016/s1130-2399(08)72749-4 -
Critical Care Medicine Dec 1998
Review
Topics: Critical Care; Hemodynamics; Humans; Prone Position; Pulmonary Gas Exchange; Pulmonary Ventilation; Respiratory Distress Syndrome
PubMed: 9875889
DOI: 10.1097/00003246-199812000-00004 -
Anesthesia and Analgesia Jan 2011
Topics: Blindness; Glaucoma, Angle-Closure; Humans; Postoperative Complications; Prone Position
PubMed: 21173205
DOI: 10.1213/ANE.0b013e3181fe772d -
Current Opinion in Anaesthesiology Dec 2014For patients requiring surgery in the prone position, an alternative to a traditional supine induction is allowing the patient to position themselves comfortably prone... (Review)
Review
PURPOSE OF REVIEW
For patients requiring surgery in the prone position, an alternative to a traditional supine induction is allowing the patient to position themselves comfortably prone and inducing anesthesia in that position. The purpose of this review is to examine the current literature and evaluate the safety of induction of anesthesia in the prone position.
RECENT FINDINGS
The first randomized trial comparing induction in the supine vs. prone position for patients requiring spinal surgery was published earlier this year and reported a time-saving benefit. Multiple case series report the feasibility of this approach; however, the potential benefits of prone induction, namely a reduction in pressure injuries and avoidance of complications of the turn itself, remain unproven. Increased familiarity with prone insertion of supraglottic airways is a useful tool in case of accidental intraoperative extubation in a patient who is already prone. Potential disadvantages include loss of the airway during induction, reduced ability to manage adverse hemodynamic consequences of induction and restriction to use of a supraglottic airway.
SUMMARY
The reviewed literature shows that elective prone induction of anesthesia using supraglottic airways, in select patients, is feasible and associated with very low complication rates; however, there is insufficient evidence to suggest that this should be done routinely.
Topics: Anesthesia, General; Humans; Patient Safety; Posture; Prone Position
PubMed: 25254571
DOI: 10.1097/ACO.0000000000000123 -
Critical Care (London, England) Jun 2022
Topics: COVID-19; Humans; Lung; Perfusion; Prone Position; Prospective Studies; Respiration, Artificial
PubMed: 35768877
DOI: 10.1186/s13054-022-04069-y