Effectiveness of prone position in acute respiratory distress syndrome and moderating factors of obesity class and treatment durations for COVID-19 patients: A Meta-Analysis

The Effect of Deep Respiration and Prone Position on Common Respiratory Symptoms in Patients with COVID-19: A Randomized Clinical Trial

Background

COVID-19 causes many respiratory problems. The most common clinical manifestation is acute respiratory failure. Respiratory rehabilitation is an important part of treatment, but little is known about it. This study was carried out to determine the effect of deep respiration and prone position on common respiratory symptoms in patients with COVID-19.

Materials and Methods

In this clinical trial that was conducted in a hospital in Yasuj city, Iran, in 2021, 96 patients with COVID-19 were selected using a non-random convenience sampling method and were randomly assigned to three groups of deep respiration, prone position, and deep respiration and prone position. Data were collected using the Borg Rating of Perceived Exertion scale, the Visual Analog Scale, pulse oximetry, and a researcher-made checklist of patients' respiratory rates. The interventions were performed for 1 week (2-8 hours daily) based on patient tolerance. Data were collected before and immediately after the intervention.

Results

There was no statistically significant difference (p > 0.05) among the three groups in terms of mean score of shortness of breath, intensity of symptoms, oxygen saturation of blood, and respiration rate before the interventions; however, significant differences were observed after the interventions (p < 0.05) in the three groups.

Conclusions

Deep respiration with prone position could improve respiratory symptoms in patients with COVID-19 more than deep respiration or prone position alone. Respiratory exercise should be considered as a part of nursing cares and patients with respiratory symptoms should receive education in this regard.

Hard Outcomes in Critically Ill Patients with Acute Respiratory Distress Syndrome Caused by SARS-CoV-2 Infection: A Retrospective Cohort Study of 3 Years of Pandemic

Background: The COVID-19 pandemic has exerted immense pressure on healthcare systems, particularly in the management of patients with acute respiratory distress syndrome (ARDS). Identifying predictors of survival in critically ill patients is crucial for optimizing treatment strategies. Methods: A retrospective cohort study was conducted in an Intensive Care Unit (ICU) in Mexico City, spanning from March 2020 to March 2023. This study included patients aged 18 years and older with confirmed COVID-19 who required invasive mechanical ventilation. Logistic regression and Kaplan–Meier analyses were performed to evaluate factors associated with mortality. Results: A total of 157 patients were included, with a mean age of 62.8 years, and 74.5% were male. The 90-day survival rate was 41.4%, with a mortality rate of 58.6%. Acute kidney injury (AKI) (OR = 3.4), hemodynamic failure (OR = 6.5), and elevated lactate levels (OR = 0.201) were significantly associated with increased mortality risk. Kaplan–Meier analysis demonstrated significantly reduced survival among patients with AKI, hemodynamic failure, and hyperlactatemia. Discussion: AKI, hemodynamic instability, and hyperlactatemia emerged as pivotal predictors of mortality. The high incidence of AKI and associated adverse outcomes underscore the urgent need for tailored management strategies in this vulnerable patient cohort. Conclusions: The 90-day survival rate was 41.4%. AKI, hemodynamic failure, and elevated lactate levels were independently associated with increased mortality, highlighting the necessity for focused and strategic interventions.

Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review

PURPOSE OF REVIEW

Since the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has infected nearly 800 million people and caused almost seven million deaths. Obesity was quickly identified as a risk factor for severe COVID-19, ICU admission, acute respiratory distress syndrome, organ support including mechanical ventilation and prolonged length of stay. The relationship among obesity; COVID-19; and respiratory, thrombotic, and renal complications upon admission to the ICU is unclear.

RECENT FINDINGS

The predominant effect of a hyperinflammatory status or a cytokine storm has been suggested in patients with obesity, but more recent studies have challenged this hypothesis. Numerous studies have also shown increased mortality among critically ill patients with obesity and COVID-19, casting doubt on the obesity paradox, with survival advantages with overweight and mild obesity being reported in other ICU syndromes. Finally, it is now clear that the increase in the global prevalence of overweight and obesity is a major public health issue that must be accompanied by a transformation of our ICUs, both in terms of equipment and human resources. Research must also focus more on these patients to improve their care. In this review, we focused on the central role of obesity in critically ill patients during this pandemic, highlighting its specificities during their stay in the ICU, identifying the lessons we have learned, and identifying areas for future research as well as the future challenges for ICU activity.

A Comprehensive Review of Prone Ventilation in the Intensive Care Unit: Challenges and Solutions

This comprehensive review explores the intricate landscape of prone ventilation in the intensive care unit (ICU), spanning physiological rationale, challenges in implementation, psychosocial impacts, technological innovations, economic considerations, barriers to adoption, and implications for clinical practice. The physiological benefits of prone positioning, including improved oxygenation and lung compliance, are discussed alongside the challenges of patient selection and technical complexities. The psychosocial impact on patients and caregivers, as well as the economic implications for healthcare systems, adds a crucial dimension to the analysis. The review also delves into innovative technologies, such as advanced monitoring and automation, shaping the landscape of prone ventilation. Moreover, it addresses the barriers to widespread adoption and outlines strategies to overcome resistance, emphasizing the need for a comprehensive and collaborative approach. The implications for clinical practice underscore the importance of evidence-based guidelines, ongoing education, and a holistic patient-centered care approach. The conclusion highlights the call to action for further research to refine protocols and technology, ultimately optimizing the application of prone ventilation in critical care settings.

Prone Positioning in Mechanically Ventilated COVID-19 Patients: Timing of Initiation and Outcomes

The COVID-19 pandemic led to a broad implementation of proning to enhance oxygenation in both self-ventilating and mechanically ventilated critically ill patients with acute severe hypoxic respiratory failure. However, there is little data on the impact of the timing of the initiation of prone positioning in COVID-19 patients receiving mechanical ventilation. In this study, we analyzed our proning practices in mechanically ventilated COVID-19 patients. There were 931 total proning episodes in 144 patients, with a median duration of 16 h (IQR 15-17 h) per proning cycle. 563 proning cycles were initiated within 7 days of intubation (early), 235 within 7-14 days (intermediate), and 133 after 14 days (late). The mean change in oxygenation defined as the delta PaO₂/FiO₂ ratio (ΔPF) after the prone episode was 16.6 ± 34.4 mmHg (p < 0.001). For early, intermediate, and late cycles, mean ΔPF ratios were 18.5 ± 36.7 mmHg, 13.2 ± 30.4 mmHg, and 14.8 ± 30.5 mmHg, with no significant difference in response between early, intermediate, and late proning (p = 0.2), respectively. Our findings indicate a favorable oxygenation response to proning episodes at all time points, even after >14 days of intubation. However, the findings cannot be translated directly into a survival advantage, and more research is needed in this area.

Risk of severe COVID-19 infection in persons with diabetes during the first and second waves in Denmark: A nationwide cohort study

OBJECTIVE

Coronavirus disease-2019 (COVID-19) increases risk of hospitalization and death in diabetes and diabetes-related conditions. We examined the temporal trends in COVID-19-related hospitalization and mortality in the total Danish population by diabetes and diabetes-related conditions in the two first waves of COVID-19 in Denmark.

MATERIALS AND METHODS

We identified all persons with diabetes in the whole Danish population using national registries. COVID-19-related risks of hospitalization and death were assessed using Cox regression analysis in wave 1 (1 March-31 August 2020) and wave 2 (1 September 2020-28 February 2021) of the pandemic for persons with (n=321,933) and without diabetes (n=5,479,755). Analyses were stratified according to status of hypertension, obesity, cardiovascular and microvascular disease.

RESULTS

The cumulative incidence of COVID-19 hospitalization increased from wave 1 to wave 2 in both persons without (from 4 to 10 in 10,000) and with diabetes (from 16 to 54 per 10,000). The relative risk of hospitalization, however, increased more in patients with diabetes compared to persons without (age-, sex- and co-morbidity-adjusted HR [aHR] 1.40 (95% CI 1.27, 1.55) versus 1.76 (1.65, 1.87), p<0.001 for interaction with wave). The mortality rate, according to the whole population, increased similarly in persons without and with diabetes from wave 1 to wave 2 (from 0.63 to 1.5 versus from 4.3 to 10 in 10,000; aHR 1.65; 1.34, 2.03 and 1.64; 1.43, 1.88). However, when mortality was restricted to the hospitalized population, the crude mortality fell from 26.8% to 19.6% in persons with diabetes, while only a minor decrease was seen in persons without diabetes (from 16.7% to 15.5%).

CONCLUSION

The risk of COVID-19-related hospitalization increased more in persons with than without diabetes from wave 1 to wave 2 of the COVID-19 pandemic in the Danish population. However, mortality according to the whole population did not change, due to reduced mortality among hospitalized persons with diabetes.