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Al Duhailib Z, Parhar KKS, Solverson K, Alhazzani W, Weatherald J. Awake prone position in patients with acute hypoxic respiratory failure: A narrative review. Respir Med Res 2023; 84:101037. [PMID: 37625375 DOI: 10.1016/j.resmer.2023.101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/03/2023] [Accepted: 06/19/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Zainab Al Duhailib
- Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; O'Brien Institute for Public Health and Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Kevin Solverson
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; Department of Medicine, Division of Respirology, University of Calgary, Calgary, Canada
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada; Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jason Weatherald
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada.
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2
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Li J, Ibarra-Estrada M, Guérin C. Prone Positioning for Patients With COVID-19-Induced Acute Hypoxemic Respiratory Failure: Flipping the Script. Respir Care 2023; 68:1449-1464. [PMID: 37722733 PMCID: PMC10506644 DOI: 10.4187/respcare.11227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
During the COVID-19 pandemic, prone positioning (PP) emerged as a widely used supportive therapy for patients with acute hypoxemic respiratory failure caused by COVID-19 infection. In particular, awake PP (APP)-the placement of non-intubated patients in the prone position-has gained popularity and hence is detailed first herein. This review discusses recent publications on the use of PP for non-intubated and intubated subjects with COVID-19, highlighting the physiological responses, clinical outcomes, influential factors affecting treatment success, and strategies to improve adherence with APP. The use of prolonged PP and the use of PP for patients undergoing extracorporeal membrane oxygenation are also presented.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois.
| | - Miguel Ibarra-Estrada
- Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde Guadalajara, Universidad de Guadalajara, Jalisco, México; Grupo Internacional de Ventilación Mecánica WeVent; and Latin American Intensive Care Network (LIVEN)
| | - Claude Guérin
- Médecine Intensive Réanimation, Hôpital Édouard Herriot, Lyon, France; Université de Lyon, Lyon, France; and Institut Mondor de Recherches Biomédicales, INSERM 955 CNRS 7000, Créteil, France
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3
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McNicholas BA, Ibarra-Estrada M, Perez Y, Li J, Pavlov I, Kharat A, Vines DL, Roca O, Cosgrave D, Guerin C, Ehrmann S, Laffey JG. Awake prone positioning in acute hypoxaemic respiratory failure. Eur Respir Rev 2023; 32:32/168/220245. [PMID: 37137508 PMCID: PMC10155045 DOI: 10.1183/16000617.0245-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/22/2023] [Indexed: 05/05/2023] Open
Abstract
Awake prone positioning (APP) of patients with acute hypoxaemic respiratory failure gained considerable attention during the early phases of the coronavirus disease 2019 (COVID-19) pandemic. Prior to the pandemic, reports of APP were limited to case series in patients with influenza and in immunocompromised patients, with encouraging results in terms of tolerance and oxygenation improvement. Prone positioning of awake patients with acute hypoxaemic respiratory failure appears to result in many of the same physiological changes improving oxygenation seen in invasively ventilated patients with moderate-severe acute respiratory distress syndrome. A number of randomised controlled studies published on patients with varying severity of COVID-19 have reported apparently contrasting outcomes. However, there is consistent evidence that more hypoxaemic patients requiring advanced respiratory support, who are managed in higher care environments and who can be prone for several hours, benefit most from APP use. We review the physiological basis by which prone positioning results in changes in lung mechanics and gas exchange and summarise the latest evidence base for APP primarily in COVID-19. We examine the key factors that influence the success of APP, the optimal target populations for APP and the key unknowns that will shape future research.
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Affiliation(s)
- Bairbre A McNicholas
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Miguel Ibarra-Estrada
- Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - Yonatan Perez
- Clinical Investigation Center, INSERM 1415, CHRU Tours, Tours, France
- Médecine Intensive Réanimation, CHRU Tours, Tours, France
- Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Ivan Pavlov
- Department of Emergency Medicine, Hôpital de Verdun, Montréal, QC, Canada
| | - Aileen Kharat
- Department of Respiratory Medicine, Geneva University Hospital, Geneva, Switzerland
| | - David L Vines
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA
| | - Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Cosgrave
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Claude Guerin
- University of Lyon, Lyon and INSERM 955, Créteil, France
| | - Stephan Ehrmann
- Clinical Investigation Center, INSERM 1415, CHRU Tours, Tours, France
- Médecine Intensive Réanimation, CHRU Tours, Tours, France
| | - John G Laffey
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
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Rama-Maceiras P, Sanduende Y, Taboada M, Casero M, Leal S, Pita-Romero R, Fernández R, López E, López JA, Pita E, Tubío A, Rodríguez A, Varela M, Campaña D, Delgado C, Lombardía M, Villar E, Blanco P, Martínez A, Sarmiento A, Díaz P, Ojea M, Rodríguez Á, Mouriz L, Cid M, Ramos L, Seoane-Pillado T. Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:70-78. [PMID: 35907774 PMCID: PMC9903149 DOI: 10.1016/j.eimce.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/20/2021] [Accepted: 06/27/2021] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in Intensive Care Units (ICU) after one year of pandemic. METHODOLOGY Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). RESULTS 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs 84%, p < 0.001), using high-flow nasal cannulas (CNAF) more frequently (70% vs 7%, p < 0.001), ventilation non-invasive mechanical (NIMV) (40% vs 14%, p < 0.001), corticosteroids (100% vs 96%, p = 0.007) and prone position in both awake (42% vs 28%, p = 0.012), and intubated patients (67% vs 54%, p = 0.034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs 17%). CONCLUSIONS After 1 year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.
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Affiliation(s)
- Pablo Rama-Maceiras
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Yolanda Sanduende
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, Spain
| | - Manuel Taboada
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, Spain.
| | - María Casero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - Sonsoles Leal
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Rafael Pita-Romero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, Spain
| | - Ricardo Fernández
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Eva López
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | - José Antonio López
- Servicio de Anestesiología y Reanimación, Hospital da Mariña, Burela, Lugo, Spain
| | - Elvira Pita
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Ana Tubío
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Arancha Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - Marina Varela
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, Spain
| | - Daniel Campaña
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Carla Delgado
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, Spain
| | - Mónica Lombardía
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Eva Villar
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | - Pilar Blanco
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Adrián Martínez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Ana Sarmiento
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - Pilar Díaz
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, Spain
| | - María Ojea
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, Spain
| | - Ángel Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, Spain
| | - Lorena Mouriz
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Milagros Cid
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, Spain
| | - Lorena Ramos
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Teresa Seoane-Pillado
- The Preventive Medicine and Public Health Sciences, University of A Coruña, A Coruña, Spain
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Rama-Maceiras P, Sanduende Y, Taboada M, Casero M, Leal S, Pita-Romero R, Fernández R, López E, López JA, Pita E, Tubío A, Rodríguez A, Varela M, Campaña D, Delgado C, Lombardía M, Villar E, Blanco P, Martínez A, Sarmiento A, Díaz P, Ojea M, Rodríguez Á, Mouriz L, Cid M, Ramos L, Seoane-Pillado T. [Critical patients COVID-19 has changed the management and outcomes in the ICU after 1 year of the pandemic? A multicenter, prospective, observational study]. Enferm Infecc Microbiol Clin 2023; 41:70-78. [PMID: 34305229 PMCID: PMC8286862 DOI: 10.1016/j.eimc.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023]
Abstract
Objective To compare the clinical characteristics, treatments, and evolution of critical patients with COVID-19 pneumonia treated in intensive care units (ICU) after one year of pandemic. Methodology Multicenter, prospective study, which included critical COVID-19 patients in 9 ICUs in northwestern Spain. The clinical characteristics, treatments, and evolution of patients admitted to the ICU during the months of March-April 2020 (period 1) were compared with patients admitted in January-February 2021 (period 2). Results 337 patients were included (98 in period 1 and 239 in period 2). In period 2, fewer patients required invasive mechanical ventilation (IMV) (65% vs. 84%, P < .001), using high-flow nasal cannulas (CNAF) more frequently (70% vs. 7%, P < .001), ventilation non-invasive mechanical (NIMV) (40% vs. 14%, P < .001), corticosteroids (100% vs. 96%, P = .007) and prone position in both awake (42% vs. 28%, P = .012), and intubated patients (67% vs. 54%, P = .034). The days of IMV, ICU stay and hospital stay were lower in period 2. Mortality was similar in the two periods studied (16% vs. 17%). Conclusions After one year of pandemic, we observed that in patients admitted to the ICU, CNAF, NIMV, use of the prone position, and corticosteroids have been used more frequently, reducing the number of patients in IMV, and the length of stay in the ICU and hospital stay. Mortality was similar in the two study periods.
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Affiliation(s)
- Pablo Rama-Maceiras
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Yolanda Sanduende
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, España
| | - Manuel Taboada
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, España
| | - María Casero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, España
| | - Sonsoles Leal
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, España
| | - Rafael Pita-Romero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España
| | - Ricardo Fernández
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, España
| | - Eva López
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, España
| | - José Antonio López
- Servicio de Anestesiología y Reanimación, Hospital da Mariña, Burela, Lugo, España
| | - Elvira Pita
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Ana Tubío
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, España
| | - Arancha Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, España
| | - Marina Varela
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, España
| | - Daniel Campaña
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, España
| | - Carla Delgado
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España
| | - Mónica Lombardía
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, España
| | - Eva Villar
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, España
| | - Pilar Blanco
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Adrián Martínez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, A Coruña, España
| | - Ana Sarmiento
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, España
| | - Pilar Díaz
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Pontevedra (CHUP), Pontevedra, España
| | - María Ojea
- Servicio de Anestesiología y Reanimación, Hospital POVISA, Vigo, Pontevedra, España
| | - Ángel Rodríguez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España
| | - Lorena Mouriz
- Servicio de Anestesiología y Reanimación, Hospital Universitario Lucus Augusti (HULA), Lugo, España
| | - Milagros Cid
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Ourense (CHUO), Ourense, España
| | - Lorena Ramos
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Teresa Seoane-Pillado
- The Preventive Medicine and Public Health Sciences, University of A Coruña, A Coruña, España
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Perez Y, Luo J, Ibarra-Estrada M, Li J, Ehrmann S. Awake prone positioning for patients with COVID-19-induced acute hypoxemic respiratory failure. JOURNAL OF INTENSIVE MEDICINE 2022; 2:233-240. [PMID: 36785650 PMCID: PMC9464348 DOI: 10.1016/j.jointm.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
Whereas prone positioning of intubated patients suffering from acute respiratory distress syndrome represents the standard of care, proning non-intubated patients, so-called "awake prone positioning (APP)," has only recently gained popularity and undergone scientific evaluation. In this review, we summarize current evidence on physiological and clinical effects of APP on patients' centered outcomes, such as intubation and mortality, the safety of the technique, factors and predictors of success, practical issues for optimal implementation, and future areas of research. Current evidence supports using APP among patients suffering from acute hypoxemic respiratory failure due to COVID-19 and undergoing advanced respiratory support, such as high-flow nasal cannula, in an intensive care unit setting. Healthcare teams should aim to prone patients at least 8 h daily. Future research should focus on optimizing the tolerance of the technique and comprehensively evaluating benefits in other patient populations.
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Affiliation(s)
- Yonatan Perez
- Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, Strasbourg 67000, France
| | - Jian Luo
- Respiratory Medicine Unit and Oxford NIHR Biomedical Research Centre, NDM Experimental Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Miguel Ibarra-Estrada
- Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde. Universidad de Guadalajara. Guadalajara, Jalisco 44280, Mexico
| | - Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL 60612, USA
| | - Stephan Ehrmann
- Médecine Intensive Réanimation, CIC 1415 INSERM, CRICS-TriggerSep F-CRIN research network, CHRU de Tours, Tours France and Centre d’étude des pathologies respiratoires (CEPR), INSERM U1100, Université de Tours, Tours 37000, France,Corresponding author: Stephan Ehrmann, Médecine Intensive Réanimation, CIC 1415 INSERM, CRICS-TriggerSep F-CRIN research network, CHRU de Tours, Tours France and Centre d’étude des pathologies respiratoires (CEPR), INSERM U1100, Université de Tours, Tours 37000, France.
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Prone position reduces the risk of patients with mild or moderate COVID-19 progressing to severe or even critical cases: a retrospective study. Eur J Med Res 2022; 27:149. [PMID: 35962440 PMCID: PMC9372953 DOI: 10.1186/s40001-022-00776-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background To investigate whether prone position can reduce the risk of patients with mild or moderate COVID-19 who progress to severe or critical illness. Methods The prone position group was treated in prone position on the day of admission in addition to conventional treatment. Indicators such as saturation of pulse oximetry (SpO2), heart rate, blood pressure, respiratory rate, and prone position-related adverse events were recorded before prone ventilation, 5 min after prone position and 30 min after prone position. Meanwhile, the cases of severe and critical patients, the percentage of transformation and the final clinical outcome of this group were analyzed. Conversion rates and mortality were calculated for patients with mild or moderate COVID-19 retrieved from the database who received only conventional care without combined prone positioning as control group. Results (1) A total of 34 patients were included in prone position group. There were significant differences in SpO2 between the first 4 days after admission and the day of discharge (F = 3.17, P < 0.001). (2) The main complications were back and neck muscle soreness (55.9%), followed by abdominal distension (8.9%). (3) In control group, a total of 4873 cases of mild and moderate patients were included from 19 literatures, with an average deterioration rate of 22.7% and mortality rate of 1.7%. (4) In prone position group, there were no severe or critical transformation cases and also no death cases. The prone position group had a significantly lower deterioration rate when compared with the control group (χ2 = 9.962, P < 0.01). Conclusion Prone position improves SpO2 in patients with mild or moderate COVID-19. It can also reduce the percentage of mild or moderate patients progressing to severe or critical patients. The application of prone position is a simple, feasible, safe and effective treatment method in such patients.
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Menga LS, Berardi C, Ruggiero E, Grieco DL, Antonelli M. Noninvasive respiratory support for acute respiratory failure due to COVID-19. Curr Opin Crit Care 2022; 28:25-50. [PMID: 34694240 PMCID: PMC8711305 DOI: 10.1097/mcc.0000000000000902] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Noninvasive respiratory support has been widely applied during the COVID-19 pandemic. We provide a narrative review on the benefits and possible harms of noninvasive respiratory support for COVID-19 respiratory failure. RECENT FINDINGS Maintenance of spontaneous breathing by means of noninvasive respiratory support in hypoxemic patients with vigorous spontaneous effort carries the risk of patient self-induced lung injury: the benefit of averting intubation in successful patients should be balanced with the harms of a worse outcome in patients who are intubated after failing a trial of noninvasive support.The risk of noninvasive treatment failure is greater in patients with the most severe oxygenation impairment (PaO2/FiO2 < 200 mmHg).High-flow nasal oxygen (HFNO) is the most widely applied intervention in COVID-19 patients with hypoxemic respiratory failure. Also, noninvasive ventilation (NIV) and continuous positive airway pressure delivered with different interfaces have been used with variable success rates. A single randomized trial showed lower need for intubation in patients receiving helmet NIV with specific settings, compared to HFNO alone.Prone positioning is recommended for moderate-to-severe acute respiratory distress syndrome patients on invasive ventilation. Awake prone position has been frequently applied in COVID-19 patients: one randomized trial showed improved oxygenation and lower intubation rate in patients receiving 6-h sessions of awake prone positioning, as compared to conventional management. SUMMARY Noninvasive respiratory support and awake prone position are tools possibly capable of averting endotracheal intubation in COVID-19 patients; carefully monitoring during any treatment is warranted to avoid delays in endotracheal intubation, especially in patients with PaO2/FiO2 < 200 mmHg.
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Affiliation(s)
- Luca S. Menga
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cecilia Berardi
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ersilia Ruggiero
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Luca Grieco
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Antonelli
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore
- Dipartimento di Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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9
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Esteban-Zubero E, García-Muro C, Alatorre-Jiménez MA, Johal V, López-García CA, Marín-Medina A. High Flow Nasal Cannula Therapy in the Emergency Department: Main Benefits in Adults, Pediatric Population and against COVID-19: A Narrative Review. ACTA MEDICA (HRADEC KRALOVE, CZECH REPUBLIC) 2022; 65:45-52. [DOI: 10.14712/18059694.2022.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
This review aims to summarize the literature’s main results about high flow nasal cannula therapy (HFNC) HFNC benefits in the Emergency Department (ED) in adults and pediatrics, including new Coronavirus Disease (COVID-19). HFNC has recently been established as the usual treatment in the ED to provide oxygen support. Its use has been generalized due to its advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure, increasing alveolar recruitment, easy adaptation due to the humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. A wide range of pathologies has been studied to evaluate the potential benefits of HFNC; some examples are heart failure, pneumonia, chronic pulmonary obstructive disease, asthma, and bronchiolitis. The regular use of this oxygen treatment is not established yet due to the literature’s controversial results. However, several authors suggest that it could be useful in several pathologies that generate acute respiratory failure. Consequently, the COVID-19 irruption has generated the question of HFNC as a safety and effective treatment. Our results suggested that HFNC seems to be a useful tool in the ED, especially in patients affected by acute hypoxemic respiratory failure, acute heart failure, pneumonia, bronchiolitis, asthma and acute respiratory distress syndrome in patients affected by COVID-19. Its benefits in hypercapnic respiratory failure are more discussed, being only observed benefits in patients with mild-moderate disease. These results are based in clinical as well as cost-effectiveness outcomes. Future studies with largest populations are required to confirm these results as well as establish a practical guideline to use this device.
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10
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Uusalo P, Valtonen M, Järvisalo MJ. Hemodynamic and respiratory effects of dexmedetomidine sedation in critically ill Covid-19 patients: A retrospective cohort study. Acta Anaesthesiol Scand 2021; 65:1447-1456. [PMID: 34368946 PMCID: PMC8441884 DOI: 10.1111/aas.13970] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 07/25/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Dexmedetomidine has been suggested to be a promising sedative for patients with Covid-19 infection (CV19). However, use of dexmedetomidine is limited by its heart rate (HR) and arterial blood pressure lowering effects. Moreover, CV19 is associated with cardiac manifestations including bradyarrythmias. The hemodynamic effects of dexmedetomidine have not been previously studied in CV19 patients. We evaluated the effects of dexmedetomidine on hemodynamic and respiratory parameters of CV19 patients. METHODS In this single center study, all CV19 patients receiving dexmedetomidine for sedation during a one year period were included. Our primary outcomes included changes in HR, mean arterial pressure (MAP), respiratory rate (RR), partial oxygen pressure of arterial blood/fraction of inspired oxygen-ratio (PF-ratio), and Richmond Agitation and Sedation Score (RASS) during dexmedetomidine administration. RESULTS We identified 39 patients with a mean (SD) age of 58.3 (12.7) years. After initiation of dexmedetomidine, HR decreased by 16.9 (3.3) beats/min (95% CI 9.5-22.4; p < 0.001). During the 12-hour follow-up period, HR decrease was significant at 2 to 12 h. Incident bradycardia (<45/min) was reported in 12 (30.8%) patients and it was associated with lower plasma C-reactive protein, Pro-calcitonin, and troponin T levels. There was no change in MAP compared to baseline. Dexmedetomidine administration was associated with improvement of PF-ratio (p < 0.001) and with decrease of RASS (p = 0.004). CONCLUSIONS Dexmedetomidine is an effective sedative for CV19 patients and may improve their oxygenation. However, dexmedetomidine administration is associated with marked decline in HR and with a high incidence of bradycardia in patients with CV19.
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Affiliation(s)
- Panu Uusalo
- Department of Anaesthesiology and Intensive Care University of Turku Turku Finland
- Perioperative Services, Intensive Care and Pain Medicine Turku University Hospital Turku Finland
| | - Mika Valtonen
- Department of Anaesthesiology and Intensive Care University of Turku Turku Finland
- Perioperative Services, Intensive Care and Pain Medicine Turku University Hospital Turku Finland
| | - Mikko J. Järvisalo
- Department of Anaesthesiology and Intensive Care University of Turku Turku Finland
- Perioperative Services, Intensive Care and Pain Medicine Turku University Hospital Turku Finland
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11
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Akoumianaki E, Ischaki E, Karagiannis K, Sigala I, Zakyn-thinos S. The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia. J Pers Med 2021; 11:jpm11090884. [PMID: 34575661 PMCID: PMC8469068 DOI: 10.3390/jpm11090884] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 01/08/2023] Open
Abstract
Acute hypoxemic respiratory failure is the principal cause of hospitalization, invasive mechanical ventilation and death in severe COVID-19 infection. Nearly half of intubated patients with COVID-19 eventually die. High-Flow Nasal Oxygen (HFNO) and Noninvasive Ventilation (NIV) constitute valuable tools to avert endotracheal intubation in patients with severe COVID-19 pneumonia who do not respond to conventional oxygen treatment. Sparing Intensive Care Unit beds and reducing intubation-related complications may save lives in the pandemic era. The main drawback of HFNO and/or NIV is intubation delay. Cautious selection of patients with severe hypoxemia due to COVID-19 disease, close monitoring and appropriate employment and titration of HFNO and/or NIV can increase the rate of success and eliminate the risk of intubation delay. At the same time, all precautions to protect the healthcare personnel from viral transmission should be taken. In this review, we summarize the evidence supporting the application of HFNO and NIV in severe COVID-19 hypoxemic respiratory failure, analyse the risks associated with their use and provide a path for their proper implementation.
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Affiliation(s)
- Evangelia Akoumianaki
- Department of Intensive Care Unit, University Hospital of Heraklion, 71500 Crete, Greece
- Correspondence:
| | - Eleni Ischaki
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, 10676 Athens, Greece; (E.I.); (I.S.); (S.Z.-t.)
| | | | - Ioanna Sigala
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, 10676 Athens, Greece; (E.I.); (I.S.); (S.Z.-t.)
| | - Spyros Zakyn-thinos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, 10676 Athens, Greece; (E.I.); (I.S.); (S.Z.-t.)
- School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece
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