Objective: Proning has been shown to improve oxygenation and mortality in certain populations of intubated patients with acute respiratory distress syndrome. Small observational analyses of COVID-19 patients suggest awake proning may lead to clinical improvement. Data on safety and efficacy is lacking. We sought to describe the effect of proning on oxygenation in nonintubated COVID-19 patients. We also evaluated feasibility, safety, and other physiological and clinical outcomes associated with this intervention.
Methods: We conducted a prospective, observational cohort study of nonintubated patients with COVID-19 who underwent proning per an Emergency Department (ED) clinical protocol. Patients with mild to moderate respiratory distress were included. We calculated change in oxygenation by comparing the oxygen saturation to fraction of inspired oxygen ratio (SpO2:FiO2) during the five minutes prior to proning and first 30 min of proning. We also captured data on respiratory rate, duration of proning, need for intubation, intensive care unit admission, survival to discharge.
Results: Fifty-two patients were enrolled. Thirty were excluded for not meeting protocol inclusion criteria or missing baseline oxygenation data, leaving 22 for analysis. The SpO2:FiO2 ratio increased by a median of 5 (IQR: 0-15) in the post-proning period compared to the pre-proning period (median: 298 (IQR: 263-352) vs 295 (IQR: 276-350), p = 0.01). Respiratory rate did not change significantly between time periods. No immediate adverse events occurred during proning. Five patients (23%) were intubated within 48 h of admission.
Conclusion: Early, awake proning may be feasible in select COVID-19 patients and was associated with improved oxygenation.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713606 | PMC |
| http://dx.doi.org/10.1016/j.ajem.2020.11.074 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
[Positioning therapy for intensive care patients].
Dtsch Med Wochenschr
August 2024
Klinik für Anästhesiologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
Article Synopsis
- - The updated S3 guideline for "Positioning Therapy and Mobilization of Critically Ill Patients" introduces significant methodological changes and evidence-based insights, focusing on a more tailored application of recommendations for better patient care in ICUs.
- - Early mobilization is emphasized to begin within 72 hours of ICU admission, supported by a structured scoring system to optimize patient rehabilitation, while suggesting specific actions such as standing and transferring from bed to chair even during treatment like ECMO.
- - New strategies include promoting semi-recumbent positioning for intubated patients, recommending prone positioning for those with ARDS, and incorporating new sections on assistive devices and neuromuscular electrical stimulation to enhance recovery processes.
Mechanical ventilation during extracorporeal membrane oxygenation support - New trends and continuing challenges.
Perfusion
April 2024
Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany.
Background: The impact of mechanical ventilation on the survival of patients supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO) due to severe acute respiratory distress syndrome (ARDS) remains still a focus of research.
Methods: Recent guidelines, randomized trials, and registry data underscore the importance of lung-protective ventilation during respiratory and cardiac support on ECMO.
Results: This approach includes decreasing mechanical power delivery by reducing tidal volume and driving pressure as much as possible, using low or very low respiratory rate, and a personalized approach to positive-end expiratory pressure (PEEP) setting.
Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient.
Arch Bronconeumol
May 2024
Servicio de Neumologia, Hospital Universitario de Araba, Spain.
Article Synopsis
- * Key aspects of managing severe cases include deciding when to start non-invasive support, recognizing treatment failures, and implementing palliative or de-escalation strategies when improvement happens.
- * The document compiles insights from four scientific societies and 25 experts to enhance care approaches for severe COVID-19, reflecting on recent evidence rather than old guidelines from acute respiratory distress syndrome.
When hope meets reality: the challenges of awake proning in unmonitored settings.
J Thorac Dis
January 2024
Pulmonology Service, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.
Acta Anaesthesiol Scand
April 2024
Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Background: Awake proning in spontaneously breathing patients with hypoxemic acute respiratory failure was applied during the coronavirus disease 2019 (COVID-19) pandemic to improve oxygenation while avoiding tracheal intubation. An updated systematic review and meta-analysis on the topic was published.
Methods: The Clinical practice committee (CPC) of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) assessed the clinical practice guideline "Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: A rapid practice guideline" for possible endorsement.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!