Background: Prone positioning (PP) is a well-known respiratory support approach. Limited data are available for the use of PP in nonintubated patients with COVID-19.
Aim: This study aims to investigate the effect of PP on the clinical outcomes of patients with COVID-19 pneumonia.
Methods: In this clinical trial, the participants in the PP group (n = 41) were asked to lie comfortably in a PP for 90 min. In the supine position (SP) group (n = 41), the participants were asked to lie comfortably in a SP for 90 min. Clinical data such as oxygen saturation, respiratory rate (RR), the severity of dyspnoea, mean arterial pressure (MAP), and pulse rate were assessed at 0 (immediately before), 30, 60, and 90 min after the start of the intervention, and 30 min after resuming the SP. The participants in the PP group were then asked to intermittently stay in a PP for a total of 8 h per 24 h of hospitalisation. The participants in the control group were asked to remain in their usual positions during the hospital stay. Finally, the length of hospital stay, intubation rate, and survival were assessed.
Findings: PP was associated with significant improvement in oxygen saturation (P = 0.001), RR (P = 0.004), the severity of dyspnoea (P = 0.014), and MAP (P = 0.027). There was no significant difference between the two groups in terms of pulse rate (P = 0.890), hospital stay (P = 0.994), intubation rate (P = 0.324), and survival (P = 0.091).
Discussion: Our results demonstrated that PP showed marked improvement in some short-term clinical outcomes in nonintubated patients with COVID-19.
Conclusion: PP can be considered an inexpensive, accessible, and simple measure in awake nonintubated patients with COVID-19.
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http://dx.doi.org/10.1016/j.colegn.2022.12.005 | DOI Listing |
Curr Opin Crit Care
January 2025
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, University of Milan, Milan, Italy.
Purpose Of Review: The increasing use of prone position, in intubated patients with acute respiratory distress syndrome as well as in patients with acute hypoxemic respiratory failure receiving noninvasive respiratory support, mandates a better definition and monitoring of the response to the manoeuvre. This review will first discuss the definition of the response to prone positioning, which is still largely based on its effect on oxygenation. We will then address monitoring respiratory and hemodynamic responses to prone positioning in intubated patients.
View Article and Find Full Text PDFCrit Care Resusc
December 2024
Australian and New Zealand Intensive Care - Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne Australia.
Objective: To describe the use of and outcomes from awake prone positioning (APP) in nonintubated patients with COVID-19 in Australian intensive care units (ICUs) in comparison to those who did not receive APP, and to explore the temporal relationship between publication of APP research and changes in clinical practice.
Design: Multicentre, observational cohort study.
Setting: Seventy-eight Australian ICUs participating in SPRINT-SARI Australia.
Sci Rep
January 2025
The Queen's Medical Center, 1301 Punchbowl Street, QET 4M, Honolulu, Hawai'i, 96813, USA.
High flow nasal cannula (HFNC) can reduce the need for intubation in patients with coronavirus disease-19 (COVID-19) pneumonia induced acute hypoxemic respiratory failure (AHRF), but predictors of HFNC success could be characterized better. C-reactive protein (CRP) and D-dimer are associated with COVID-19 severity and progression. However, no one has evaluated the use of serial CRP and D-dimer ratios to predict HFNC success.
View Article and Find Full Text PDFCurr Opin Anaesthesiol
February 2025
Department of Anesthesia, Intensive Care and Emergency, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.
Purpose Of Review: This review discusses nonintubated video-assisted thoracic surgery (NIVATS) by presenting its physiological, technical aspects and recent clinical data from the literature.
Recent Findings: In the last two decades, NIVATS has gained traction as an alternative to traditional intubated thoracic surgery, offering potential benefits in terms of reduced complications, faster recovery times, and improved patient satisfaction. Several approaches to this technique have been described in the literature, mainly divided into the awake patient technique (awake-NIVATS) and the asleep patient technique (asleep-NIVATS).
CHEST Crit Care
December 2024
Division of Pulmonary, Allergy, and Critical Care (G. L. A.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; the Division of Pulmonary and Critical Care Medicine (S. M. S.), University of Rochester Medical Center, Rochester, NY; the Department of Anaesthesia and Critical Care (A. R., Z. F., and M. T. D. S.), Greys Hospital, KwaZulu-Natal Department of Health, the Department of Anaesthesia and Critical Care (J. I.), Harry Gwala Regional Hospital, KwaZulu-Natal Department of Health, Pietermaritzburg, the Department of Anaesthesia and Critical Care (R. D. W. and M. T. D. S.), School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa; the Faculty Medicine and Pharmacy (R. D. W.), Vrije Universiteit Brussel (VUB), Brussels, Belgium; and the Department of Intensive Care (R. D. W.), John Radcliffe Hospital, Oxford University Trust Hospitals, Oxford, England.
Background: A proposed new global definition of ARDS seeks to update the Berlin definition and account for nonintubated ARDS and ARDS diagnoses in resource-variable settings.
Research Question: How do ARDS epidemiologic characteristics change with operationalizing the new global definition of ARDS in a resource-limited setting?
Study Design And Methods: We performed a real-use retrospective cohort study among adult patients meeting criteria for the Berlin definition of ARDS or the global definition of ARDS at ICU admission in two public hospitals in the KwaZulu-Natal Department of Health, South Africa, from January 2017 through June 2022.
Results: Among 5,760 adults (aged ≥ 18 years) admitted to the ICU, 2,027 patients (35.
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