Awake Prone Positioning in the Management of COVID-19 Pneumonia: A Systematic Review

Abstract

Background: The aim was to investigate the efficacy of prone positioning (PP) in the management of coronavirus disease-2019 (COVID-19) pneumonia in various setups, with various modes of oxygen therapy and its optimal duration. Materials and methods: A systematic literature search was conducted from inception until May 15, 2021. Patients with a validated diagnosis of COVID-19 and receiving PP were included. Various factors, including intensive care unit (ICU) or non-ICU setup, mode of oxygen therapy, outcome, duration of proning, and limitations, were noted. Results: We retrieved 36 articles with a total of 1,385 patients for qualitative analysis. Out of 36 articles, there were 17 original articles, 09 case series, and 10 case reports. Out of 1,385 participants, 78.9% ( n = 1,093) and 21.0% ( n = 292) of patients were managed in ICU and non-ICU setup, respectively. Awake PP with high flow nasal cannula (HFNC) was found to be a promising technique; however, the result was inconclusive with helmet continuous positive airway pressure (CPAP). No study has evaluated the optimal duration of awake PP and the associated long-term outcomes. Conclusion: We encourage the use of early awake self-proning in the management of COVID19 disease. However, the evidence in terms of its use in non-ICU setup, the optimal duration of PP, and various oxygenation devices are insufficient, thereby mandating further well-designed multicentric studies to evaluate its efficacy as an adjunct in the management of COVID-19 pneumonia in context to the aforementioned factor. How to cite this article: Chilkoti GT, Mohta M, Saxena AK, Ahmad Z, Sharma CS. Awake Prone Positioning in the Management of COVID-19 Pneumonia: A Systematic Review. Indian J Crit Care Med 2021;25(8):896–905.

Importance of Physical Therapy Interventions for Medically Complex Patient With Severe COVID-19: A Case Report

“…Proning had been completed at the community hospital before ECMO implantation which has also been documented as an effective intervention to oxygenate the lungs. 14,15 The proning guidelines for patients with COVID-19 were based on the treatment recommendations published on patients with ARDS with documented results in increased lung volume, perfusion, and even ventilation distribution. 15 Owing to the medical complexity and limited activity tolerance of most patients with COVID-19, an interdisciplinary treatment approach may be beneficial to maximize gains.…”