ABSTRACT
Background Prone position (PP) ventilation has become an effective and simple treatment for acute respiratory distress syndrome (ARDS) due to COVID-19; however, prolonged prone position not only leads to patient discomfort, but also reduces patient compliance, and is prone to causing adverse events such as pressure injuries, pain, and dizziness. We aim to explore the effects of modular new prone positioning tools in patients with ARDS due to COVID-19.Methods 168 patients with ARDS due to COVID-19 were selected; however, 92 were later disqualified. 76 patients were randomly assigned to the observation group (n = 38) and the control group (n = 38). The observation group used modular new prone positioning tools to implement prone ventilation therapy while the control group used soft pillows to implement prone ventilation therapy. Comfort indicators (including time spent implementing PP, duration of PP, number of postural adjustments during PP, and duration time when first needing to adjust position), adverse events (including artificial airway kinking, shortness of breath, dizziness, and stress injury), and efficacy indicators (including intubation and mortality) were collected. The feeling of comfort, the occurrence of adverse events, and the efficacy of two groups of patients were also evaluated.Results The observation group had shorter time spent implementing PP(2.74 ± 0.86 vs. 4.64 ± 1.02, P < 0.001), longer duration of PP (14.02 ± 1.01 vs. 13.03 ± 0.66, P < 0.001), duration time when first needing to adjust position (59.89 ± 12.73 vs. 36.57 ± 8.69, P < 0.001), and lower number of postural adjustments during PP (11.03 ± 2.67 vs. 17.95 ± 2.58, P < 0.001) in comparison with the control group. No significant differences in intubation (9 vs. 11, P = 0.602) and mortality (4 vs. 6, P = 0.602) were found in both groups. However, in terms of adverse events, the observation group showed lower artificial airway kinking (5 vs. 23, P < 0.001), pain (7 vs. 21, P = 0.001), shortness of breath (2 vs. 9, P = 0.022), dizziness (0 vs. 5, P = 0.021), and stress injury (7 vs. 26, P < 0.001) than the control group.Conclusion Utilizing modular new prone position tools to implement prone ventilation therapy not only improves the efficiency of prone position execution and patient comfort, but also reduces the incidence of adverse events. However, it cannot change the intubation rate and mortality rate of patients.
Subject(s)
Pain , Respiratory Distress Syndrome , Dyspnea , Dizziness , COVID-19 , Stress Disorders, Traumatic, AcuteABSTRACT
Covering: up to 2020As a main bioactive component of the Chinese, Indian, and American Podophyllum species, the herbal medicine, podophyllotoxin (PTOX) exhibits broad spectrum pharmacological activity, such as superior antitumor activity and against multiple viruses. PTOX derivatives (PTOXs) could arrest the cell cycle, block the transitorily generated DNA/RNA breaks, and blunt the growth-stimulation by targeting topoisomerase II, tubulin, or insulin-like growth factor 1 receptor. Since 1983, etoposide (VP-16) is being used in frontline cancer therapy against various cancer types, such as small cell lung cancer and testicular cancer. Surprisingly, VP-16 (ClinicalTrials NTC04356690) was also redeveloped to treat the cytokine storm in coronavirus disease 2019 (COVID-19) in phase II in April 2020. The treatment aims at dampening the cytokine storm and is based on etoposide in the case of central nervous system. However, the initial version of PTOX was far from perfect. Almost all podophyllotoxin derivatives, including the FDA-approved drugs VP-16 and teniposide, were seriously limited in clinical therapy due to systemic toxicity, drug resistance, and low bioavailability. To meet this challenge, scientists have devoted continuous efforts to discover new candidate drugs and have developed drug strategies. This review focuses on the current clinical treatment of PTOXs and the prospective analysis for improving druggability in the rational design of new generation PTOX-derived drugs.