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Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers.
Stilma, Willemke; Åkerman, Eva; Artigas, Antonio; Bentley, Andrew; Bos, Lieuwe D; Bosman, Thomas J C; de Bruin, Hendrik; Brummaier, Tobias; Buiteman-Kruizinga, Laura A; Carcò, Francesco; Chesney, Gregg; Chu, Cindy; Dark, Paul; Dondorp, Arjen M; Gijsbers, Harm J H; Gilder, Mary Ellen; Grieco, Domenico L; Inglis, Rebecca; Laffey, John G; Landoni, Giovanni; Lu, Weihua; Maduro, Lisa M N; McGready, Rose; McNicholas, Bairbre; de Mendoza, Diego; Morales-Quinteros, Luis; Nosten, Francois; Papali, Alfred; Paternoster, Gianluca; Paulus, Frederique; Pisani, Luigi; Prud'homme, Eloi; Ricard, Jean-Damien; Roca, Oriol; Sartini, Chiara; Scaravilli, Vittorio; Schultz, Marcus J; Sivakorn, Chaisith; Spronk, Peter E; Sztajnbok, Jaques; Trigui, Youssef; Vollman, Kathleen M; van der Woude, Margaretha C E.
  • Stilma W; 1Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
  • Åkerman E; 2Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Science, Amsterdam, The Netherlands.
  • Artigas A; 3Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
  • Bentley A; 4Function of Perioperative Medicine and Intensive Care, Department of Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
  • Bos LD; 5Department of Intensive Care, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Sabadell, Barcelona, Spain.
  • Bosman TJC; 6Autonomous University of Barcelona, Sabadell, Barcelona, Spain.
  • de Bruin H; 7Acute Intensive Care Unit, Manchester University NHS Foundation, Manchester, United Kingdom.
  • Brummaier T; 8Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
  • Buiteman-Kruizinga LA; 1Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
  • Carcò F; 1Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
  • Chesney G; 1Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
  • Chu C; 9Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
  • Dark P; 10Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
  • Dondorp AM; 1Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
  • Gijsbers HJH; 11Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands.
  • Gilder ME; 12Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Grieco DL; 13Division of Emergency Medicine-Critical Care, Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York.
  • Inglis R; 9Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
  • Laffey JG; 10Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
  • Landoni G; 14Critical Care Medicine, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom.
  • Lu W; 15Division of Infection, Immunity and Respiratory Medicine, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom.
  • Maduro LMN; 16Humanitarian and Conflict Response Institute, University of Manchester, Manchester, United Kingdom.
  • McGready R; 10Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
  • McNicholas B; 17Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.
  • de Mendoza D; 18Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
  • Morales-Quinteros L; 19Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
  • Nosten F; 20Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Papali A; 21Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy.
  • Paternoster G; 22Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, University of Oxford, Vientiane, Lao People's Democratic Republic.
  • Paulus F; 23Department of Anaesthesia and Intensive Care, MedicineGalway University Hospitals, Galway, Ireland.
  • Pisani L; 24School of Medicine, Disciplines of Anaesthesia and Intensive Care Medicine, National University of Ireland, Galway, Ireland.
  • Prud'homme E; 12Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Ricard JD; 25School of Medicine, Vita Salute San Raffaele University, Milan, Italy.
  • Roca O; 26Department of Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, China.
  • Sartini C; 18Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
  • Scaravilli V; 9Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
  • Schultz MJ; 10Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
  • Sivakorn C; 23Department of Anaesthesia and Intensive Care, MedicineGalway University Hospitals, Galway, Ireland.
  • Spronk PE; 27Intensive Care Department, Hospital Universitari Sagrat Cor. Grupo Quironsalud, Barcelona, Spain.
  • Sztajnbok J; 28Emergency Department, Hospital Universitari Sagrat Cor. Grupo Quironsalud, Barcelona, Spain.
  • Trigui Y; 29Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
  • Vollman KM; 27Intensive Care Department, Hospital Universitari Sagrat Cor. Grupo Quironsalud, Barcelona, Spain.
  • van der Woude MCE; 30Institut d' Investigacio I Innovacio Parc Taulí I3PT, Universidad Autonoma de Barcelona, Barcelona, Spain.
Am J Trop Med Hyg ; 104(5): 1676-1686, 2021 Mar 11.
Article in English | MEDLINE | ID: covidwho-1128113
Semantic information from SemMedBD (by NLM)
1. Adjuvant Therapy TREATS Hypoxemia
Subject
Adjuvant Therapy
Predicate
TREATS
Object
Hypoxemia
2. COVID-19 CAUSES Acute respiratory failure
Subject
COVID-19
Predicate
CAUSES
Object
Acute respiratory failure
3. Pneumonia caused by SARS-CoV-2 PROCESS_OF Patients
Subject
Pneumonia caused by SARS-CoV-2
Predicate
PROCESS_OF
Object
Patients
4. Pneumonia caused by SARS-CoV-2 COEXISTS_WITH Hypoxemia
Subject
Pneumonia caused by SARS-CoV-2
Predicate
COEXISTS_WITH
Object
Hypoxemia
5. Pneumonia caused by SARS-CoV-2 AFFECTS Patients
Subject
Pneumonia caused by SARS-CoV-2
Predicate
AFFECTS
Object
Patients
6. Alveolar ventilation function PROCESS_OF Patients
Subject
Alveolar ventilation function
Predicate
PROCESS_OF
Object
Patients
7. adjunctive treatment TREATS Hypoxemia
Subject
adjunctive treatment
Predicate
TREATS
Object
Hypoxemia
8. Adjuvant Therapy TREATS Hypoxemia
Subject
Adjuvant Therapy
Predicate
TREATS
Object
Hypoxemia
9. COVID-19 CAUSES Acute respiratory failure
Subject
COVID-19
Predicate
CAUSES
Object
Acute respiratory failure
10. Pneumonia caused by SARS-CoV-2 PROCESS_OF Patients
Subject
Pneumonia caused by SARS-CoV-2
Predicate
PROCESS_OF
Object
Patients
11. Pneumonia caused by SARS-CoV-2 COEXISTS_WITH Hypoxemia
Subject
Pneumonia caused by SARS-CoV-2
Predicate
COEXISTS_WITH
Object
Hypoxemia
12. Pneumonia caused by SARS-CoV-2 AFFECTS Patients
Subject
Pneumonia caused by SARS-CoV-2
Predicate
AFFECTS
Object
Patients
13. Alveolar ventilation function PROCESS_OF Patients
Subject
Alveolar ventilation function
Predicate
PROCESS_OF
Object
Patients
14. adjunctive treatment TREATS Hypoxemia
Subject
adjunctive treatment
Predicate
TREATS
Object
Hypoxemia
ABSTRACT
Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6-12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Insufficiency / Prone Position / SARS-CoV-2 / COVID-19 / Hypoxia Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Am J Trop Med Hyg Year: 2021 Document Type: Article Affiliation country: Ajtmh.20-1445

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Insufficiency / Prone Position / SARS-CoV-2 / COVID-19 / Hypoxia Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Am J Trop Med Hyg Year: 2021 Document Type: Article Affiliation country: Ajtmh.20-1445