Subject(s)
COVID-19 , Patient Positioning/methods , Prone Position/physiology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/therapy , Female , France/epidemiology , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Oxygen Inhalation Therapy/methods , Research Design , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed/methodsABSTRACT
Prone positioning reduces mortality in the management of intubated patients with moderate-to-severe acute respiratory distress syndrome. It allows improvement in oxygenation by improving ventilation/perfusion ratio mismatching.Because of its positive physiological effects, prone positioning has also been tested in non-intubated, spontaneously breathing patients, or "awake" prone positioning. This review provides an update on awake prone positioning for hypoxaemic respiratory failure, in both coronavirus disease 2019 (COVID-19) and non-COVID-19 patients. In non-COVID-19 acute respiratory failure, studies are limited to a few small nonrandomised studies and involved patients with different diseases. However, results have been appealing with regard to oxygenation improvement, especially when combined with noninvasive ventilation or high-flow nasal cannula.The recent COVID-19 pandemic has led to a major increase in hospitalisations for acute respiratory failure. Awake prone positioning has been used with the aim to prevent intensive care unit admission and mechanical ventilation. Prone positioning in conscious, non-intubated COVID-19 patients is used in emergency departments, medical wards and intensive care units.Several trials reported an improvement in oxygenation and respiratory rate during prone positioning, but impacts on clinical outcomes, particularly on intubation rates and survival, remain unclear. Tolerance of prolonged prone positioning is an issue. Larger controlled, randomised studies are underway to provide results concerning clinical benefit and define optimised prone positioning regimens.
Subject(s)
COVID-19/therapy , Lung/physiopathology , Patient Positioning , Prone Position , Respiratory Insufficiency/therapy , Wakefulness , COVID-19/physiopathology , COVID-19/virology , Humans , Lung/virology , Recovery of Function , Respiration , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/virology , Treatment OutcomeABSTRACT
Condition:
Coronavirus Infection;Oxygen DeficiencyIntervention:
Procedure: Prone positioningPrimary outcome:
Proportion of "responder" patients to prone positionCriteria:
Inclusion Criteria:
- Patient aged at least 18 years;
- Hospitalized in a COVID unit or intensive care unit;
- Spontaneously breathing and with oxygen therapy with nasal canula, mask or High Flow
Oxygen Therapy;
- Requiring oxygen therapy = 1l for Sat = 90%;
- COVID 19 positive in RT-PCR or diagnosis on clinicals symptoms and highly evocatives
scannographics lesions in an epidemic period;
- Chest scanner without injection within 72 hours prior to inclusion;
- Bilateral scannographic lesions, including posterior condensations and/or posterior
predominance of lesions;
- Patient benefiting from French social security, under any regime
Exclusion Criteria:
- acute respiratory distress (polypnea >25 or use of accessory respiratory muscles);
- Alteration of consciousness;
- Active or recent hemoptysis (<1 month);
- Recent Thrombo-Embolic Venous Disease (< 1 month);
- Pericardial effusion;
- Pleural effusion of high abundance, clinical or scannographic;
- Chronic back or cervical pain/ history of spinal surgery/ bone metastases;
- Wounds, facial trauma, tracheal, sternal or facial surgery < 15 days;
- Recent abdominal surgery (< 1 month);
- Intracranial HyperTension > 30mmHg;
- Patient deprived of liberty, under guardianship or curatorship;
- Pregnant or lactating woman.