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American Journal of Respiratory and... Jun 2021
Topics: Humans; Patient Positioning; Prone Position
PubMed: 33556302
DOI: 10.1164/rccm.202101-0156ED -
Annals of Cardiac Anaesthesia 2016Mechanical ventilation remains the cornerstone in the management of severe acute respiratory failure. Acute respiratory distress syndrome (ARDS) is the most common cause... (Review)
Review
Mechanical ventilation remains the cornerstone in the management of severe acute respiratory failure. Acute respiratory distress syndrome (ARDS) is the most common cause of respiratory failure. It is associated with substantial mortality, and unmanageable refractory hypoxemia remains the most feared clinical possibility. If hypoxemia persists despite application of lung protective ventilation, additional therapies including inhaled vasodilators, prone positioning, recruitment maneuvers, high-frequency oscillatory ventilation, neuromuscular blockade (NMB), and extracorporeal membrane oxygenation may be needed. NMB and prone ventilation are modalities that have been clearly linked to reduced mortality in ARDS. Rescue therapies pose a clinical challenge requiring a precarious balance of risks and benefits, as well as, in-depth knowledge of therapeutic limitations.
Topics: Extracorporeal Membrane Oxygenation; Humans; Hypoxia; Prone Position; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 26750680
DOI: 10.4103/0971-9784.173030 -
CMAJ : Canadian Medical Association... Feb 2021
Review
Topics: COVID-19; Contraindications, Procedure; Humans; Oxygen Inhalation Therapy; Prone Position; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory Insufficiency; Respiratory Physiological Phenomena
PubMed: 33526550
DOI: 10.1503/cmaj.201201-f -
Pneumologie (Stuttgart, Germany) Feb 2020
Topics: Humans; Lung; Patient Positioning; Prone Position; Respiration
PubMed: 32050281
DOI: 10.1055/a-0978-0893 -
Critical Care (London, England) Aug 2023The effects of awake prone position on the breathing pattern of hypoxemic patients need to be better understood. We conducted a crossover trial to assess the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The effects of awake prone position on the breathing pattern of hypoxemic patients need to be better understood. We conducted a crossover trial to assess the physiological effects of awake prone position in patients with acute hypoxemic respiratory failure.
METHODS
Fifteen patients with acute hypoxemic respiratory failure and PaO/FiO < 200 mmHg underwent high-flow nasal oxygen for 1 h in supine position and 2 h in prone position, followed by a final 1-h supine phase. At the end of each study phase, the following parameters were measured: arterial blood gases, inspiratory effort (ΔP), transpulmonary driving pressure (ΔP), respiratory rate and esophageal pressure simplified pressure-time product per minute (sPTP) by esophageal manometry, tidal volume (V), end-expiratory lung impedance (EELI), lung compliance, airway resistance, time constant, dynamic strain (V/EELI) and pendelluft extent through electrical impedance tomography.
RESULTS
Compared to supine position, prone position increased PaO/FiO (median [Interquartile range] 104 mmHg [76-129] vs. 74 [69-93], p < 0.001), reduced respiratory rate (24 breaths/min [22-26] vs. 27 [26-30], p = 0.05) and increased ΔP (12 cmHO [11-13] vs. 9 [8-12], p = 0.04) with similar sPTP (131 [75-154] cmHO s min vs. 105 [81-129], p > 0.99) and ΔP (9 [7-11] cmHO vs. 8 [5-9], p = 0.17). Airway resistance and time constant were higher in prone vs. supine position (9 cmHO s arbitrary units [4-11] vs. 6 [4-9], p = 0.05; 0.53 s [0.32-61] vs. 0.40 [0.37-0.44], p = 0.03). Prone position increased EELI (3887 arbitrary units [3414-8547] vs. 1456 [959-2420], p = 0.002) and promoted V distribution towards dorsal lung regions without affecting V size and lung compliance: this generated lower dynamic strain (0.21 [0.16-0.24] vs. 0.38 [0.30-0.49], p = 0.004). The magnitude of pendelluft phenomenon was not different between study phases (55% [7-57] of V in prone vs. 31% [14-55] in supine position, p > 0.99).
CONCLUSIONS
Prone position improves oxygenation, increases EELI and promotes V distribution towards dependent lung regions without affecting V size, ΔP, lung compliance and pendelluft magnitude. Prone position reduces respiratory rate and increases ΔP because of positional increases in airway resistance and prolonged expiratory time. Because high ΔP is the main mechanistic determinant of self-inflicted lung injury, caution may be needed in using awake prone position in patients exhibiting intense ΔP. Clinical trail registeration: The study was registered on clinicaltrials.gov (NCT03095300) on March 29, 2017.
Topics: Humans; Prone Position; Respiration; Respiratory Insufficiency; Tidal Volume; Wakefulness; Cross-Over Studies
PubMed: 37592288
DOI: 10.1186/s13054-023-04600-9 -
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 -
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 -
British Journal of Anaesthesia Feb 2008Prone positioning of patients during anaesthesia is required to provide operative access for a wide variety of surgical procedures. It is associated with predictable... (Review)
Review
Prone positioning of patients during anaesthesia is required to provide operative access for a wide variety of surgical procedures. It is associated with predictable changes in physiology but also with a number of complications, and safe use of the prone position requires an understanding of both issues. We have reviewed the development of the prone position and its variants and the physiological changes which occur on prone positioning. The complications associated with this position and the published techniques for various practical procedures in this position will be discussed. The aim of this review is to identify the risks associated with prone positioning and how these risks may be anticipated and minimized.
Topics: Anesthesia; Hemodynamics; Humans; Intraoperative Care; Intraoperative Complications; Postoperative Complications; Prone Position; Respiratory Mechanics
PubMed: 18211991
DOI: 10.1093/bja/aem380 -
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